Travel Nurse RN - Case Management
Plainville, MA
Prime Staffing
5x8 hrs, Days

We are seeking an experienced RN Case Manager to join a busy Acute Care Hospital. This position is responsible for coordinating patient care, managing utilization review activities, facilitating discharge planning, and ensuring appropriate resource utilization while promoting quality patient outcomes. 

Minimum Qualifications

• Active Registered Nurse (RN) License
• Minimum 3 years of Acute Care Case Management experience
• Bachelor's Degree required
• Current BLS Certification
• Case Management Certification (CCM, ACM, or equivalent)
• Experience with:
  • Utilization Review
  • Denials Management
  • Care Coordination
  • Discharge Planning
  • Interdisciplinary Care Management

Traveler Requirements

• First-time travelers are welcome to apply.

Key Responsibilities

• Coordinate patient care throughout hospitalization and discharge.
• Perform utilization review to ensure medical necessity and appropriate level of care.
• Manage insurance denials, appeals, and authorization processes.
• Develop and implement discharge plans to facilitate safe transitions of care.
• Collaborate with physicians, nurses, social workers, payers, and ancillary departments.
• Assess patient needs and identify barriers to discharge.
• Coordinate post-acute services and community resources.
• Maintain accurate and timely clinical documentation.
• Ensure compliance with regulatory, payer, and hospital requirements.

Required Skills

• Acute Care Case Management
• Utilization Review
• Denials Management
• Discharge Planning
• Care Coordination
• Patient Advocacy
• Resource Management
• Clinical Documentation
• Regulatory Compliance
• Interdisciplinary Collaboration

Certifications & Education

✔ BLS Certification Required
✔ Case Management Certification Required
✔ Bachelor's Degree Required