RN Case Manager / per-diem

RN Case Manager coordinates, negotiates, procures services and resources for SSH&EC clients, acts as a patient advocate, and manages care of complex patients to achieve quality and cost-efficient outcomes. Uses InterQual criteria and payor guidelines to determine medical necessity for admission and continued stay; provides clinically-based case management, discharge planning, and care coordination across the continuum. Collaborates with interdisciplinary staff, participates in quality improvement, and supports prompt, safe discharge planning. Responsibilities include reviewing medical records for observation/admission status, communicating with physicians for documentation and status changes, arranging referrals to appropriate services, and ensuring timely transitions of care while supporting utilization management and reimbursement processes. Minimum education: RN; preferred Bachelor’s degree; required RN licensure and CCM/ACM certification within two years; 3-5 years acute care hospital experience preferred; strong negotiation, communication, conflict resolution, and critical-thinking skills; proficiency with EHR systems (eDischarge, InterQual, MCCM, Epic, Workday). The role requires a minimum of 32 hours weekly with night/weekend shifts and at least one major holiday per season, located in Scituate, MA.