RN Case Manager / per-diem
On-site · Kingston, Massachusetts, United States
Job Summary
RN Case Manager responsible for clinically-based case management, discharge planning, and care coordination to ensure quality, cost-effective patient outcomes. Roles include reviewing medical records for observation/admission status, determining medical necessity using InterQual criteria, coordinating with physicians and payers, facilitating timely discharge planning, and maintaining documentation for reimbursement. Requires collaboration across interdisciplinary teams, management of resources, ongoing quality improvement participation, and adherence to payer guidelines to optimize patient care and LOS. Licensure as RN with CCM/ACM certification within two years is required and Bachelor’s degree strongly preferred; 3-5 years of acute care hospital experience is preferred.
Required Qualifications
- RN - Registered Nurse
- CCM or ACM certification preferred within two years of hire
- Bachelor's degree strongly preferred (BSN preferred)
- Minimum 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Knowledge of InterQual criteria
- Strong negotiation and communication skills
- Knowledge of healthcare financing and utilization management
- EHR/EMR familiarity (eDischarge, InterQual, MCCM, Epic, Workday)
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