Case Management Registered Nurse - CMRN 26-11262

Case Management Registered Nurse (RN)

Location: Hyannis, MA
Duration: 13 Weeks
Shift: 40 Hours/Week; Rotating Days
Shift Time: 8:00 AM – 4:30 PM
Weekend Requirement: Every Other Weekend
Holiday Requirement: Rotating Holidays

Weekly Gross: $2,800–$3,000/Week (Based on Experience)

Job Description

We are seeking an experienced Case Management Registered Nurse (RN) to facilitate and coordinate patient care across assigned populations and hospital units. The ideal candidate will have strong acute-care experience, utilization review expertise, and discharge planning skills, along with the ability to collaborate effectively with physicians, patients, families, insurance providers, and interdisciplinary teams.

Responsibilities

• Facilitate and coordinate patient care for assigned patient populations and units.
• Assess patient needs using established standards, Care Maps, InterQual®, and approved clinical guidelines.
• Screen new admissions daily for discharge planning needs and prioritize visits accordingly.
• Review admission appropriateness and level of care for inpatient and observation patients.
• Conduct reassessments when there are changes in medical status, diagnosis, or caregiver circumstances.
• Coordinate discharge planning and ensure care plans align with patient needs and covered services.
• Facilitate third-party reimbursement by providing timely and accurate clinical information to insurance payers.
• Coordinate patient appeal rights and communicate adverse determinations and insurance coverage issues.
• Identify high-risk psychosocial, financial, and legal needs and connect patients and families with appropriate resources.
• Perform utilization reviews for assigned units and identify days at risk for denial.
• Collaborate closely with physicians and interdisciplinary teams to facilitate appropriate care and services.
• Participate in daily rounds, care conferences, and the development or revision of clinical pathways.
• Coordinate complete referral information to support safe patient transfers to other facilities or agencies.
• Assist medical coders by providing diagnostic and procedural information required for appropriate reimbursement.
• Maintain accurate documentation and complete all required paperwork.
• Serve as a patient advocate and encourage patient and family participation in care decisions.
• Maintain compliance with departmental policies, quality assurance, safety, infection control, regulatory, and payer requirements.
• Maintain clinical competency and participate in education, in-services, and staff meetings.
• Work independently while effectively managing multiple priorities in a fast-paced healthcare environment.

Requirements

• Current, active Massachusetts RN license.
• Minimum 3 years of acute-care experience within the past 5 years, with broad clinical hospital experience or case management experience.
• Recent Discharge Planning and Utilization Review experience within the past 4 years.
• Working knowledge of InterQual® or an equivalent utilization-review system.
• Acute Care and InterQual experience required.
• Ability to read, write, and communicate effectively in English.
• BSN preferred.
• Case Management, CPUM, or specialty certification preferred.
• Strong interpersonal, communication, negotiation, and patient advocacy skills.
• Excellent organizational and time-management abilities.
• Ability to work independently and effectively in a fast-paced and stressful environment.
• Proficient computer skills with the ability to adapt to updated software systems.