RN - Case Management - CMRN 26-13460

JOB TITLE: RN – Case Management

JOB OVERVIEW

Location: Hyannis, MA 02601
Job type: Contract (no benefits)
Duration: 13 weeks
Shift: Day shift
Schedule: 40 hours per week, rotating days, 4 x 10-hour shifts, every other weekend, rotating holidays

Candidates needed: Both local and traveling candidates

COMPENSATION

Local candidates: $68 – $70 per hour, based on experience
Traveling candidates: $70 – $73 per hour, based on experience

RESPONSIBILITIES

Care Coordination and Discharge Planning

• Coordinate and facilitate patient care, discharge planning and transitions to ensure high-quality, efficient and cost-effective care.
• Screen new admissions daily for discharge planning needs and prioritize patient assessments.
• Complete initial assessments within one business day of identifying patient needs, and perform reassessments every three days as needed.
• Develop and maintain individualized care plans and discharge plans aligned with patient needs and covered services.
• Coordinate referrals and communicate complete information to ensure safe transfers to other facilities or community agencies.
• Identify patients with complex psychosocial, financial or legal needs and connect them with appropriate resources.
• Advocate for patients and families while promoting patient independence and continuity of care.

Utilization Review and Reimbursement

• Conduct utilization reviews and evaluate admission status, level of care and continued length of stay using InterQual criteria.
• Prepare and submit concurrent clinical documentation to insurance providers within required timeframes.
• Facilitate patient appeals, HINN notices, discharge appeals and other insurance-related processes.
• Identify potential reimbursement denials and implement strategies to prevent them and facilitate timely discharge.
• Collaborate with medical coders to obtain the diagnostic and procedural information needed for appropriate reimbursement.

Collaboration and Meetings

• Coordinate with physicians, interdisciplinary teams, patients, families, insurance companies and third-party payers to support appropriate care and reimbursement.
• Participate in daily unit rounds, care conferences and interdisciplinary meetings.

Compliance and Competency

• Maintain compliance with departmental policies, regulatory requirements, quality assurance standards, safety procedures and infection control guidelines.
• Maintain clinical competency, documentation accuracy and current knowledge of payer requirements.

REQUIRED QUALIFICATIONS

• Current Registered Nurse (RN) license in Massachusetts.
• Minimum of 3 years of acute care experience within the past 5 years, with broad clinical experience in a hospital setting or case management.
• Recent experience in discharge planning and utilization review within the past 4 years.
• Working knowledge of InterQual or an equivalent clinical review system.
• Strong clinical assessment, care coordination and discharge planning skills.
• Excellent interpersonal, communication, negotiation, organizational and time-management skills.
• Ability to work independently in a fast-paced, high-stress environment while managing multiple priorities.
• Proficiency with computer systems and clinical documentation software.
• Ability to read, write and communicate effectively in English.

PREFERRED QUALIFICATIONS

• Bachelor of Science in Nursing (BSN).
• Certification in Case Management, CPUM or a relevant specialty.