Case Manager - Registered Nurse

STI; Cambridge (MA); On-site; USD 90,000 - 115,000; Full time

Job summary

Beth Israel Deaconess Medical Center in Cambridge, MA is seeking a Case Manager - Registered Nurse to support inpatient utilization review, discharge planning, and care coordination. This 40-hour week role requires active MA RN license and Epic experience, with local candidates only.

The position involves a 3-6 month contract, day shifts, and weekend rotation as needed. Candidates must meet regulatory requirements and collaborate with physicians and care teams to optimize patient outcomes.

Qualifications

• Bachelor's degree preferred; current state license as a Registered Nurse.
• Three years of medical/surgical nursing care experience; two years in case management or utilization management.
• Basic computer and typing skills.
• Effective verbal communication skills and problem solving and conflict resolution skills.
• Demonstrated ability to organize and work independently.

Responsibilities

• Performs utilization review and discharge planning for inpatient admissions.
• Applies InterQual Inpatient criteria approved by MACIPA.
• Communicates with attending and house staff regarding inpatient options.
• Uses clinical expertise to determine appropriate level of care.
• Coordinates discharge with MAH nursing and social work staff.
• Identifies days not meeting acute hospital level of care criteria.
• Works with patients and families to plan post-hospital care.
• Manages observation status patients with physicians.
• Participates in Saturday, holiday and beeper rotation.
• Adheres to insurance, contractual, and regulatory requirements.
• Follows MACIPA Case Management standards.

Skills

Verbal communication

Problem solving

Conflict resolution

Organizational skills

Typing

Basic computer skills

Education

Bachelor's degree

Job description

Case Manager - Registered Nurse

Cambridge, MA/Local candidates not accepted***

3-6 Months

Description / Comment

Shift: 40 hours per week Usually M-F 8-4:30 Occasional weekend may be required Epic experience preferred COVID Vaccines + Booster required at time of submission (declinations not accepted). BILH cover sheet required--- Active MA license required at time of submissions Cannot have worked perm/travel for any Beth Israel facility within the past 6 months.

Primary Responsibilities

• Performs utilization review and discharge planning to inpatient admissions to MAH.
• Applies InterQual Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient and outpatient care.
• Communicates with attending and house staff when options to inpatient care are identified.
• Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options.
• Works with MAH nursing and social work staff to coordinate and facilitate patient discharge.
• Identifies days not meeting acute hospital level of care criteria and reports them to the physician reviewer.
• Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs.
• Accurately manages observation status patients by working with physicians to ensure appropriate utilization.
• Is part of the department's Saturday, holiday and beeper rotation as needed.
• Adheres to all insurance, contractual, and regulatory requirements as mandated.
• Abides by MACIPA Case Management standards as per the MACIPA CM guidelines.

Required Qualifications

• Bachelor's degree preferred. Current state license as a Registered Nurse
• Three years of medical/surgical nursing care experience. Two years of case management or utilization management experience required.
• Basic computer and typing skills.
• Effective verbal communication skills and problem solving and conflict resolution skills.
• Demonstrated ability to organize and work independently.