Job Title: Case Management RN – Emergency Department
Location: Hyannis, MA 02601
Assignment Type: 13-Week Contract
Shift: 11:00 AM – 9:30 PM
Pay Rate: $65 – $68/hour
We are seeking an experienced and proactive Registered Nurse - Case Manager for a 13-week contract assignment in the Emergency Department. This role is essential for the timely coordination and facilitation of care plans that support high-quality, cost-effective, and patient-centered outcomes. The Case Manager works collaboratively with the interdisciplinary team and external partners to optimize care delivery and ensure smooth transitions.
Screen new admissions daily for discharge planning needs and prioritize cases accordingly.
Complete Initial Assessments in InterQual® within one business day of identified needs; reassess every three days as necessary.
Evaluate appropriateness of admission and level of care using InterQual® Criteria and escalate when criteria are not met.
Manage utilization reviews, ensuring timely and accurate submission of clinical information to third-party payers.
Issue HINN Notices and appeal letters; coordinate patient appeal rights under the Discharge Appeals process.
Collaborate closely with attending physicians and interdisciplinary teams to align care plans with medical needs and insurance coverage.
Facilitate safe and effective transitions of care through complete referrals and coordination with community resources.
Participate in unit rounds, care conferences, and pathway development initiatives.
Act as a patient advocate, supporting informed decision-making and addressing insurance or discharge-related concerns.
Support medical coding efforts with complete and accurate clinical documentation.
Current Massachusetts RN license in good standing.
Bachelor of Science in Nursing (preferred for external candidates).
Certification in Case Management (CCM, CPUM, or equivalent) preferred.
Minimum 3 years of acute care experience in a hospital setting within the past 5 years.
Recent experience in discharge planning and utilization review within the past 4 years.
Proficiency in InterQual® or comparable utilization review tools.
Strong communication, negotiation, organizational, and time-management skills.
Ability to work independently and manage multiple priorities in a fast-paced environment.
Proficient in computer systems and documentation tools.