RN - Case Manager - Hyannis, MA - MS 26-11262

Job Title: Registered Nurse - Case Manager
Location: Hyannis, MA
Job Type: Contract
Duration: 13 Weeks
Shift & Schedule: Day Shift | 8:00 AM – 4:30 PM | Monday – Friday | 40 Hours/Week | Rotating Days, Every Other Weekend & Rotating Holidays
Local Candidates Required: No
Traveler Candidates Required: Yes

Pay Rate: $70 – $76/hr

Position Overview

We are seeking an experienced RN Case Manager to coordinate discharge planning, utilization review, and patient care across an acute care hospital setting.

Required Qualifications

• Current Massachusetts Registered Nurse (RN) license.

• Minimum 3 years of acute care experience within the past 5 years in a hospital or case management setting.

• Recent discharge planning and utilization review experience within the past 4 years.

• Working knowledge of InterQual® or an equivalent utilization review system.

• Strong clinical assessment, communication, organization, negotiation, and time-management skills.

• Proficient computer skills and ability to adapt to updated software systems.

• Ability to work independently in a fast-paced environment.

• BSN preferred.

• Case Management, CPUM, or specialty certification preferred.

Responsibilities

• Screen admissions for discharge planning and care coordination needs.

• Assess patient needs using InterQual®, Care Maps, clinical pathways, and established standards.

• Perform utilization review and evaluate admission and continued length-of-stay appropriateness.

• Develop and coordinate individualized discharge and care plans with the interdisciplinary team.

• Coordinate with physicians, patients, families, insurance companies, and third-party payers.

• Provide clinical information to payers and identify patients at risk for denials.

• Coordinate appeals, discharge appeal rights, HINN notices, and related documentation.

• Identify complex psychosocial, financial, and legal needs and connect patients with appropriate resources.

• Participate in daily unit rounds and care conferences.

• Coordinate patient referrals and transfers to other facilities or agencies.

• Maintain accurate documentation and required paperwork while supporting compliance with hospital policies and regulatory standards.