RN Case Manager / per-diem
On-site · Marshfield, Massachusetts, United States
Job Summary
RN Case Manager coordinates, negotiates, procures services and resources for SSH&EC clients under Case Management supervision. Acts as patient advocate to manage care of complex patients for quality and cost-efficient outcomes, applies InterQual criteria to determine medical necessity for admission and continued stay, provides clinically-based case management, discharge planning and care coordination to facilitate cost-effective quality healthcare, collaborates with interdisciplinary staff, participates in quality improvement, and commits to at least 32 hours with a mix of night/weekend shifts every 4 weeks, plus one major holiday. Responsibilities include reviewing medical records for observation/inpatient status, ensuring appropriate utilization, contacting physicians for documentation and admission decisions, arranging prompt discharge planning, coordinating resources with payers, and maintaining knowledge of payers’ requirements and resources; uses tools like InterQual, EHR (Epic, MCCM), and pays attention to regulatory standards and quality initiatives.
Required Qualifications
- RN - Registered Nurse
- ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire
- Bachelor's degree strongly preferred
- Minimum 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Demonstrated skills in negotiation, communication, conflict resolution, interdisciplinary collaboration, management, problem solving, time management, multitasking in high stress environment
- Knowledge of healthcare financing, utilization management, post-acute care resources
- Experience with Managed Care preferred
- Excellent verbal and written communication skills
- Flexibility to adapt to changing priorities and regulations
- Basic computer skills
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