Case Manager - Registered Nurse

STI; United (PA); On-site; USD 70,000 - 90,000; Full time

Job summary

STI is seeking a Case Manager - Registered Nurse in Cambridge, MA. The role involves performing utilization reviews, discharge planning, and ensuring patient care meets regulatory standards. The position requires an active MA RN license, three years of medical/surgical nursing experience, and two years in case management.

Additional qualifications include effective communication skills and the ability to work independently. Candidates must have Epic experience and be willing to adhere to COVID vaccination protocols.

Qualifications

• Must possess an active MA license at submission.
• Three years of medical/surgical nursing care experience required.
• Two years of case management or utilization management experience required.

Responsibilities

• Performs utilization review and discharge planning to inpatient admissions.
• Communicates with attending and house staff about inpatient care options.
• Coordinates and facilitates patient discharge with nursing and social work.
• Adheres to all insurance, contractual, and regulatory requirements.

Skills

Epic Experience

Effective verbal communication

Problem solving

Conflict resolution

Basic computer skills

Education

Bachelor's degree preferred

Current state license as a Registered Nurse

Job description

Case Manager - Registered Nurse

Cambridge, MA – Local candidates not accepted***

Duration: 6 months

Shift

40 hours per week. Usually M-F 8-4:30. Occasional weekend may be required.

Requirements

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 submission.

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.