Case Management Registered Nurse - CMRN 26-03576

NavitasPartners • Barnstable, MA

2d • Onsite

About The Position

A reputable healthcare facility is seeking an experienced Case Management RN to coordinate and facilitate patient care, ensuring appropriate utilization of healthcare services and effective discharge planning. This role plays a critical part in optimizing patient outcomes while maintaining cost-effective care and regulatory compliance.

Requirements

• Minimum 3 years of acute care experience within the past 5 years required
• Recent experience in discharge planning and utilization review required
• Experience with InterQual® or similar utilization management systems required
• Active Massachusetts RN license required

Nice To Haves

• Bachelor of Science in Nursing (BSN) preferred
• Case Management certification (CCM, CPUM, or equivalent) preferred

Responsibilities

• Screen new admissions daily to identify discharge planning needs
• Conduct patient assessments using InterQual® or equivalent criteria
• Perform utilization review and evaluate appropriateness of level of care
• Develop and coordinate individualized care and discharge plans
• Collaborate with physicians, interdisciplinary teams, and third-party payers
• Facilitate patient appeals and manage HINN notices as required
• Identify high-risk patients and coordinate appropriate interventions
• Participate in interdisciplinary rounds and care conferences
• Maintain accurate and timely documentation
• Coordinate patient transfers, referrals, and continuity of care
• Support reimbursement processes and respond to payer inquiries
• Monitor length of stay and implement strategies to prevent denials
• Ensure compliance with regulatory standards and facility policies

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees