RN Case Manager - RNCMVP#001

Job Title: RN Case Manager – Emergency Department

Location: Hyannis, MA

Duration: 13 Weeks

Hours per Week: 37.5

Schedule: 11:00 PM – 7:00 AM | Every Other Weekend and Holiday Required

Pay Rate: $56–$66/hour

We are seeking a skilled and compassionate RN Case Manager to join the Emergency Department team at a leading healthcare facility in Hyannis, MA. The RN Case Manager will play a critical role in coordinating patient care to ensure high-quality, cost-effective outcomes. This position requires strong collaboration with the interdisciplinary team, expertise in discharge planning, and an understanding of payer guidelines and utilization review standards.

• Conduct daily screenings of new admissions for discharge planning needs

• Prioritize cases based on screening outcomes and verify demographic and payer information

• Apply InterQual® criteria to assess admission status (Inpatient/Observation)

• Initiate and manage HINN notices and patient appeal rights

• Collaborate with healthcare providers to develop and coordinate individualized care plans

• Advocate for patients and families regarding care decisions and insurance coverage

• Facilitate communication with third-party payers to secure reimbursement

• Refer patients to appropriate community resources for post-discharge care

• Monitor length of stay and collaborate with Physician Advisor as needed

• Coordinate safe and timely patient transfers to other facilities or services

• Ensure thorough and timely discharge and referral documentation

• Maintain up-to-date knowledge of regulatory and payer guidelines

• Deliver professional and compassionate service aligned with organizational values

• Minimum of 3 years of acute care experience in a hospital or case management setting

• Recent experience in Discharge Planning and Utilization Review (within the last 4 years)

• Active RN license in Massachusetts

• Bachelor’s Degree in Nursing preferred

• Case Management Certification (CCM, CPUM, or related) preferred

• Excellent communication, organizational, and negotiation skills