RN Case Manager / per-diem
On-site · Braintree, Massachusetts, United States
Job Summary
RN Case Manager / per-diem coordinates, negotiates, and procures services for complex patients under Case Management; reviews medical necessity using InterQual criteria, conducts discharge planning, and collaborates with interdisciplinary teams to optimize quality and cost-effectiveness of care. Responsibilities include reviewing observation/inpatient status, coordinating transitions to appropriate care settings, communicating with physicians and payers, arranging referrals to post-acute services, and supporting timely discharge while maintaining documentation, adherence to payor requirements, and utilization management. Requires RN licensure, CCM/ACM certification within two years, and 3-5 years acute care experience; Bachelor's degree strongly preferred.
Required Qualifications
- RN - Registered Nurse
- Minimum Education: RN; Preferred: Bachelors prepared
- Required Certifications: ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire
- Minimum Work Experience: 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Knowledge of InterQual Criteria, utilization management, discharge planning, and care coordination
- Knowledge of healthcare financing and payer requirements
- Excellent communication and multitasking in high-stress environment
- Active nursing license in good standing
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