Hospital Case Manager (RN) - Case Management

Baystate Health • Palmer, MA

11h • Onsite

About The Position

Baystate Health is seeking a Hospital Case Manager (RN) to join our Case Management team at Wing Hospital in Palmer, Massachusetts. Our Case Management team works collaboratively with physicians, nurses, social workers, payers, patients, families, and community partners to ensure patients receive the right care at the right time and in the most appropriate setting. The Hospital Case Manager (RN) plays a critical role in coordinating patient-centered care throughout the hospitalization and transition process. This position offers the opportunity to positively impact patient outcomes by facilitating safe discharges, reducing readmissions, optimizing resource utilization, and supporting continuity of care across the healthcare continuum. Working in a community hospital setting, you will build strong interdisciplinary relationships while helping patients and families navigate complex healthcare needs.

Requirements

• Bachelor's Degree in Nursing (BSN) required.
• Current Registered Nurse (RN) license in Massachusetts.
• Minimum of 3-5 years of recent acute medical-surgical nursing experience.
• Strong clinical assessment, care coordination, and interdisciplinary collaboration skills.
• Knowledge of utilization management, discharge planning, and regulatory requirements.

Nice To Haves

• 1-3 years of Case Management experience in an acute care hospital setting.
• Experience with utilization review, payer communications, and discharge planning.
• Case Management certification (ACM, CCM, or equivalent) preferred.
• Experience working in interdisciplinary healthcare teams and navigating complex patient care transitions.

Responsibilities

• Coordinate and facilitate patient-centered care plans, collaborating with interdisciplinary teams to promote quality outcomes and appropriate utilization of healthcare resources.
• Review admissions and continued stays using established utilization management criteria and provide recommendations regarding length of stay, level of care, and quality initiatives.
• Communicate with insurance providers and payer organizations to support authorization processes and optimize reimbursement opportunities.
• Lead discharge planning efforts, ensuring patients and families understand post-acute care options, available resources, and transition plans.
• Identify patients at risk for readmission and implement interventions designed to improve outcomes and reduce avoidable hospitalizations.
• Collaborate with physicians, nursing staff, social workers, and community agencies to support seamless transitions across care settings.
• Participate in daily interdisciplinary progression rounds, focusing on timely care progression and achievement of expected lengths of stay.
• Maintain accurate and timely documentation of utilization review activities, discharge planning interventions, and post-acute care arrangements within the medical record.

Benefits

• Medical, dental, and vision coverage, including local Health New England plans.
• Tuition assistance, CEUs, and professional development opportunities.
• Clinical advancement, leadership development, and internal career opportunities.
• Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts.
• Retirement savings and employer match.
• Generous PTO for eligible employees.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level