RN, Acute Care Case Manager - Full Time

SolutionHealth • Nashua, NH

11d • Onsite

About The Position

The RN Acute Care Case Manager evaluates patients’ health status, support systems, and care needs to facilitate safe and effective discharge planning. This role develops multidisciplinary, culturally appropriate, and age-specific discharge plans while managing utilization review processes, determining appropriate levels of care, and coordinating care transitions. The RN Acute Care Case Manager works collaboratively with physicians, clinical staff, patients, families, and community resources to optimize patient outcomes and ensure compliance with regulatory and insurance requirements.

Requirements

• Bachelor’s degree in Nursing
• Current Registered Nurse (RN) licensure in the State of New Hampshire required.
• Minimum of 3-5 years of case management-related healthcare experience required.
• Seven (7) years of case management-related healthcare experience may be substituted for the bachelor’s degree requirement.
• Knowledge of care coordination principles and practices.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office applications.
• Strong analytical thinking and critical decision-making abilities.
• Ability to manage competing priorities in a fast-paced healthcare environment.
• Ability to collaborate effectively across interdisciplinary teams.
• Ability to achieve competency in: Abuse reporting, Guardianship, Discharge planning and case coordination, Community resource referrals, Utilization review

Nice To Haves

• Case Manager Certification preferred.
• Experience with InterQual, MCG, Milliman, or other healthcare acute care criteria preferred.
• Acute care utilization review and/or discharge planning experience preferred.

Responsibilities

• Evaluate patient health status, caregiver capabilities, and support systems to facilitate discharge planning.
• Develop and coordinate multidisciplinary discharge plans that support safe transitions of care.
• Perform utilization review activities and determine appropriate levels of care using InterQual criteria.
• Conduct concurrent clinical reviews and communicate with insurance providers to support authorization and prevent denials.
• Review medical records to assess medical necessity and utilization of services throughout the patient stay.
• Coordinate patient-centered discharge planning meetings with the care team.
• Participate in interdisciplinary care planning and patient-care team huddles.
• Ensure patients and families receive appropriate post-discharge resources and have choice in agency or facility selection.
• Collaborate with physicians, nurses, therapists, social workers, and community agencies to improve care coordination.
• Mobilize resources to achieve clinical outcomes within desired timeframes.
• Serve as a resource regarding utilization review processes and support appeals as needed.
• Ensure compliance with discharge planning regulations and standards.
• Issue Important Messages from Medicare within required timeframes.
• Participate in quality improvement and performance improvement initiatives.
• Maintain confidentiality and protect patient privacy.
• Perform other duties as assigned.

Benefits

• Health, dental, prescription, and vision coverage for full-time & part-time employees
• Medical, dental, and vision coverage
• Life insurance
• Short- and long-term disability
• Flexible Spending Accounts (FSA)
• Competitive pay
• Tuition Reimbursement
• Nursing Student Loan Paydown Program
• 403(b) Retirement Savings Plan
• Education & Paid training courses for continued career progression

What This Job Offers

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