RN Case Manager - Emergency Department - RNVP
Position Title: RN Case Manager – Emergency Department
Location: Hyannis, MA
Contract Duration: 13 Weeks
Hours per Week: 37.5
Shift: 11:00 PM – 7:00 AM | Every other weekend & holiday required
Pay Rate: $56–$66/hour
Conduct daily screenings of admissions to identify discharge planning needs.
Prioritize cases, verify demographic and insurance information, and ensure compliance with payer requirements.
Apply InterQual® criteria to determine appropriate admission status (Inpatient/Observation).
Initiate and manage HINN notices, patient appeal rights, and related documentation.
Collaborate with providers to develop and coordinate individualized patient care plans.
Advocate for patients and families regarding care decisions, coverage, and resources.
Communicate with third-party payers to secure appropriate reimbursement.
Refer patients to community-based services for post-discharge care.
Monitor patient length of stay and escalate cases to the Physician Advisor as necessary.
Coordinate safe and timely patient transfers to appropriate facilities or services.
Maintain accurate, thorough, and timely discharge and referral documentation.
Stay current on regulatory requirements, payer guidelines, and case management best practices.
Minimum of 3 years of recent acute care experience in a hospital or case management setting.
Direct experience in Discharge Planning and Utilization Review (within the last 4 years).
Active RN license in the state of Massachusetts.
Bachelor’s Degree in Nursing (BSN) preferred.
Case Management Certification (CCM, CPUM, or related) preferred.
Strong communication, negotiation, and organizational skills.
Ability to work independently while collaborating effectively with an interdisciplinary team.
Knowledge of InterQual® criteria and payer/utilization management guidelines.
Interested candidates can submit their resumes to [email protected] or call 516-806-4227 for more information.
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