Registered Nurse - Case Manager - RNCM25-24421

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

Position Overview:

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.

Key Responsibilities:

• 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.

Qualifications:

• 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.