RN - Case Management / Utilization Review - RNRR

Job Description

Job Description

Registered Nurse (RN) – Case Management / Utilization Review

Location: Hyannis, MA 02601
Duration: 27 Weeks
Shift: Day Shift
Hours: 40 Hours Per Week
Schedule: Monday – Friday | 8-Hour Shifts
On-Call: Rotating Weekend and Holiday Coverage Required

We are seeking an experienced Registered Nurse (RN) with a strong background in Case Management, Utilization Review, and Care Coordination for a long-term assignment in Hyannis, Massachusetts. This leadership-focused role is responsible for overseeing case management operations, supporting utilization review activities, facilitating discharge planning, and promoting quality patient outcomes within an acute care environment.

Requirements:

• Active Massachusetts Registered Nurse (RN) License required.

• Bachelor of Science in Nursing (BSN) required.

• Minimum 5 years of acute care Case Management experience required.

• Minimum 3 years of recent acute care hospital experience within the last 5 years required.

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

• Strong knowledge of discharge planning, utilization management, and care coordination.

• Experience with process improvement initiatives.

• Experience developing and presenting professional education programs.

• Knowledge of CMS regulations.

• Strong computer proficiency and familiarity with Windows-based systems.

• Excellent leadership, communication, analytical, and organizational skills.

Preferred Qualifications:

• Master's Degree in Nursing or related healthcare field.

• Case Management Certification (CCM, ACM) preferred.

• Clinical Documentation Integrity certification preferred.

• Previous management or supervisory experience.

• Experience leading multidisciplinary teams.

Responsibilities:

• Oversee daily operations of Case Management, Utilization Review, and Social Work services.

• Manage staff scheduling, workflow coordination, evaluations, and team development.

• Support Clinical Documentation Improvement (CDI) initiatives.

• Conduct patient care rounds to identify discharge barriers and facilitate care transitions.

• Develop and deliver educational programs for healthcare professionals.

• Monitor departmental performance metrics and regulatory compliance.

• Create and maintain operational and quality performance dashboards.

• Identify process improvement opportunities and implement corrective action plans.

• Mentor and coach interdisciplinary teams to improve collaboration and patient outcomes.

• Analyze program data and departmental performance trends.

• Ensure compliance with CMS regulations and industry best practices.

• Promote a culture of continuous improvement and operational excellence.

For more details contact at [email protected] or Call / Text at 516-862-1169 .

About Navitas Healthcare, LLC:
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.