Travel Nurse RN - Care Manager
Hyannis, MA
Prime Time Healthcare Nursing
3x12 hrs, Days
Referral Bonus

RN Case Manager – Cape Cod Hospital

Location: Massachusetts
Setting: Acute-care hospital
Specialty: Case Management, Utilization Review and Discharge Planning
Required Skills: Acute-care experience and InterQual

Required Qualifications

• Active Massachusetts RN license
• Minimum 3 years of acute-care hospital or case-management experience within the past 5 years
• Recent discharge-planning and utilization-review experience within the past 4 years
• Working knowledge of InterQual or a comparable system
• Strong knowledge of payer and regulatory requirements
• Proficiency with electronic documentation and healthcare software
• BSN preferred
• Case Management, CPUM or related specialty certification preferred

Primary Responsibilities

• Screen new admissions daily for discharge-planning needs
• Complete identified initial assessments within one business day
• Document initial assessments and continued-stay reviews using InterQual
• Reassess patients approximately every three days or when clinical or caregiver circumstances change
• Determine the appropriate inpatient or observation level of care
• Perform utilization review for the assigned unit
• Monitor length of stay and identify cases at risk for denial
• Refer cases to the physician advisor when medical-necessity criteria are not met
• Issue HINN notices and reinstatement letters when appropriate
• Coordinate discharge appeals and explain adverse coverage decisions
• Communicate concurrent clinical information to third-party payers
• Collaborate with physicians and the interdisciplinary care team
• Participate in daily rounds and patient-care conferences
• Develop safe discharge plans and coordinate transfers to facilities, agencies and community resources
• Address complex psychosocial, financial and legal needs through appropriate referrals
• Support medical coding by obtaining required diagnostic and procedural information
• Ensure care plans align with patient needs, available benefits and covered services

Ideal Candidate

The successful RN will be highly organized, comfortable working independently and able to manage changing priorities in a fast-paced hospital environment. Strong communication, negotiation, patient advocacy and interdisciplinary collaboration skills are essential.