Registered Nurse, RN Case Manager - Per Diem

Tufts Medicine • Lowell, MA

1d • $49 - $62

About The Position

The Registered Nurse Case Manager manages care for an assigned patient population across the continuum of care, working to achieve clinical, quality, and cost outcomes through coordinated services and collaboration among patients, families, interdisciplinary teams, physicians, and third-party payers. The role includes assessing patient needs, developing and implementing comprehensive care plans, coordinating resources and referrals, and advocating for patient preferences and treatment goals.

The Case Manager conducts assessments and multidisciplinary rounds, reviews and adjusts care and discharge plans, evaluates resource utilization, and coordinates transitions between levels of care. The position also supports documentation and utilization review, responds to payer requests, monitors quality indicators, and maintains knowledge of clinical, regulatory, and payer requirements. The role is per diem.

Requirements

• Associate degree in Nursing.
• Basic Life Support (BLS) certification.
• Registered Nurse (RN) license.
• Three years of case management experience.
• Working knowledge of InterQual or a designated screening tool.
• Ability to provide care across the lifespan with consideration of aging processes, human development stages, and cultural patterns.
• Ability to incorporate professional, clinical, legal, and ethical standards into daily practice, including patient rights and confidentiality.

Nice To Haves

• Bachelor’s degree in Nursing.

Responsibilities

• Assess new admissions and determine appropriate case management services.
• Conduct daily multidisciplinary rounds and coordinate assessment, diagnostic information, treatment, and continuing care needs.
• Discuss estimated length of stay, treatment, discharge planning, and resource utilization with physicians and the healthcare team.
• Ensure interdisciplinary care and discharge plans align with the patient’s clinical course, covered services, and continuing care needs.
• Identify complex psychosocial, financial, or legal discharge planning needs and refer patients and families to social work.
• Apply clinical, quality, insurance, and finance knowledge to patient-level and case-type decision-making and problem-solving.
• Maintain positive working relationships with referral agencies and liaisons to enhance patient flow.
• Collect and report information for quality projects, including CHF, readmissions within 30 days, delay-day variances, risk management, and quality improvement.
• Document patient and family progress toward discharge, critical events, and case management activities in the medical record and designated systems.
• Support the EMR and computer programs, including SoftMed and Soarian.
• Use InterQual criteria to review admission appropriateness, continued-stay needs, and discharge information requirements.
• Respond promptly to third-party payer requests for concurrent clinical information and ensure medical-record documentation supports admission and continued stay.
• Coordinate with admitting, financial counselors, insurance case managers, finance, screeners, and documentation specialists as appropriate.
• Complete discharge-planning and coordination functions, including case identification, high-risk screening, assessment, goal setting, implementation, monitoring, and evaluation, with a goal of completion within 24 hours.
• Coordinate discharge activities, initiate appropriate referrals to continuing-care agencies, and facilitate patient transfers between levels of care.
• Coordinate services such as home health, hospice, home infusion, durable medical equipment, and transportation.
• Facilitate communication among the interdisciplinary team, involve patients in decision-making, advocate for patient preferences, and help prevent fragmented services.
• Provide information about community resources and options, identify barriers or risks to care, and educate patients and families about disease- and treatment-related symptoms and consequences.
• Maintain clinical competency and current knowledge of regulatory and payer requirements, and provide superior customer service to internal and external clients, customers, and patients.

Benefits

• Tufts Medicine states that it provides a comprehensive Total Rewards package supporting health, financial security, and career growth; specific benefits are not listed.

What This Job Offers

• Career Level: Senior
• Education Level: Associate degree