Case Management RN (Emergency Department) - CMRNED 0318 IS#01

NavitasPartners•Barnstable, MA

1d•$65 - $70

About The Position

A healthcare facility in Hyannis, MA is seeking an experienced Case Management Registered Nurse (RN) to support the Emergency Department . This role is responsible for coordinating and facilitating patient care to ensure high-quality, cost-effective outcomes , while supporting discharge planning, utilization review, and patient advocacy in a fast-paced acute care environment.

Requirements

Active Massachusetts RN License
Minimum 3 years of acute care experience (within the last 5 years)
Experience with: Acute Care settings
Epic EMR system
InterQual® or equivalent utilization review tools
Knowledge of discharge planning and utilization review processes
Strong communication, organizational, and time-management skills
Ability to work independently in a fast-paced environment

Nice To Haves

Bachelor of Science in Nursing (BSN)
Case Management Certification (CCM, CPUM, or similar)
Prior experience in Emergency Department case management

Responsibilities

Conduct daily admission reviews and identify discharge planning needs
Perform initial patient assessments within one business day using InterQual® or equivalent tools
Complete reassessments every 3 days or as patient condition changes
Evaluate level of care appropriateness (Inpatient vs Observation)
Coordinate discharge planning and transitions of care
Collaborate with physicians, nurses, and interdisciplinary teams
Facilitate insurance authorization and reimbursement processes
Respond to payer requests with timely and accurate documentation
Identify high-risk patients and connect them with appropriate resources
Participate in daily rounds and care conferences
Support patient rights , including appeals and coverage discussions
Ensure compliance with clinical guidelines, policies, and regulatory standards
Maintain accurate and complete case management documentation