Travel Case Manager – LPN/RN (Emergency Department) - TCM25-24421

Job Title: Travel Case Manager – LPN/RN (Emergency Department)
Location: Hyannis, MA 02601
Duration: 13 Weeks
Shift: 11:00 AM – 9:30 PM or 11:30 AM – 10:00 PM
Type: Contract

Position Summary:

A leading healthcare facility in Hyannis, MA is seeking an experienced Travel Emergency Department Case Manager (LPN or RN) for a 13-week travel assignment. The Case Manager will play a vital role in ensuring high-quality care coordination, discharge planning, and utilization management for patients within the fast-paced ED environment. This role requires a combination of clinical expertise, strong communication skills, and knowledge of insurance protocols to support positive outcomes and continuity of care.

Key Responsibilities:

Clinical Assessment & Planning:

• Screen new ED admissions daily for discharge needs

• Complete and update InterQual® assessments as required

• Determine Inpatient vs. Observation status and validate appropriately

• Identify and refer complex psychosocial or financial issues

Utilization Review & Reimbursement:

• Conduct reviews to ensure efficient resource use and payer compliance

• Interface with insurance providers to secure authorizations and documentation

• Issue appropriate payer notices (e.g., HINNs) and assist with appeals

Discharge Planning & Coordination:

• Collaborate with interdisciplinary team to develop safe discharge plans

• Participate in ED rounds and maintain timely communication

• Arrange transfers and referrals, ensuring documentation is complete

Patient Advocacy & Communication:

• Act as a liaison for patients and families regarding coverage and care plans

• Support patient-centered care and shared decision-making

Documentation & Compliance:

• Maintain thorough records in the EHR and according to regulatory standards

• Work with coders and documentation specialists to ensure accurate reimbursements

• Track and report days at risk for insurance denials

Team Support & Development:

• Stay current with case management protocols and payer guidelines

• Attend departmental education, meetings, and contribute to quality initiatives

Qualifications:

Education:

• Graduate of an accredited nursing program (LPN or RN)

• Bachelor of Science in Nursing (BSN) preferred

Licensure/Certifications:

• Active and unencumbered Massachusetts LPN or RN license

• Certification in Case Management (CCM, CPUR, CPUM) preferred

Experience:

• 3+ years of recent acute care experience in a hospital setting (within past 5 years)

• 2+ years in case management, discharge planning, and utilization review

• Familiarity with InterQual® or comparable utilization review tools

Skills:

• Strong written and verbal communication

• Excellent organizational and critical thinking skills

• Proficient in electronic health records (EHRs) and computer systems

• Ability to work effectively in a high-acuity, team-based ED environment