RN Case Manager / per-diem
On-site · Braintree, Massachusetts, United States
Job Summary
RN Case Manager position responsible for reviewing medical records for admission/continued stay necessity, coordinating and negotiating services, discharge planning, and care coordination to achieve cost-effective, high-quality patient outcomes. Utilizes InterQual and payer criteria to determine medical necessity, communicates with physicians and payers to support appropriate status and documentation, and leads transitions of care across settings. Requires strong collaboration with interdisciplinary teams, documentation, and knowledge of post-acute resources, with a focus on reducing length of stay while maintaining quality. Requires minimum 32 hours weekly with at least 16 hours during night/weekend shifts per 4-week schedule and one major holiday.
Required Qualifications
- RN license
- Registered Nurse
- ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire
- Bachelor's degree strongly preferred (BSN preferred)
- 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Knowledge of InterQual Criteria
- Knowledge of payer requirements and utilization management
- Strong negotiation, communication, and interdisciplinary collaboration skills
- Proficient with EHR systems (eDischarge, Epic, MCCM, etc.)
- Licensure and certifications maintained/CEU requirements
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