RN Case Manager â Emergency Department - RNVP
RN Case Manager â Emergency Department - RNVP
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Job Description
Position Title: RN Case Manager Emergency Department
Location: Hyannis MA
Contract Duration: 13 Weeks
Hours per Week: 37.5
Shift: 11:00 PM 7:00 AM Every other weekend & holiday required
Pay Rate: $56$66/hour
Responsibilities:
Conduct daily screenings of admissions to identify discharge planning needs.
Prioritize cases verify demographic and insurance information and ensure compliance with payer requirements.
Apply InterQual criteria to determine appropriate admission status (Inpatient/Observation).
Initiate and manage HINN notices patient appeal rights and related documentation.
Collaborate with providers to develop and coordinate individualized patient care plans.
Advocate for patients and families regarding care decisions coverage and resources.
Communicate with third-party payers to secure appropriate reimbursement.
Refer patients to community-based services for post-discharge care.
Monitor patient length of stay and escalate cases to the Physician Advisor as necessary.
Coordinate safe and timely patient transfers to appropriate facilities or services.
Maintain accurate thorough and timely discharge and referral documentation.
Stay current on regulatory requirements payer guidelines and case management best practices.
Required Skills & Qualifications
Minimum of 3 years of recent acute care experience in a hospital or case management setting.
Direct experience in Discharge Planning and Utilization Review (within the last 4 years).
Active RN license in the state of Massachusetts.
Bachelors Degree in Nursing (BSN) preferred.
Case Management Certification (CCM CPUM or related) preferred.
Strong communication negotiation and organizational skills.
Ability to work independently while collaborating effectively with an interdisciplinary team.
Knowledge of InterQual criteria and payer/utilization management guidelines.
Interested candidates can submit their resumes to or call for more information.
Required Experience:
Exec
Employment Type
Hourly
