Case Manager RN

Portsmouth Regional Hospital - New Hampshire; Portsmouth (NH); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Comprehensive medical benefits

401(k) plan with company match

Tuition assistance

Job summary

Portsmouth Regional Hospital - New Hampshire is looking for a Case Manager in Portsmouth, NH. This role involves conducting utilization reviews, discharge planning, and patient assessments, ensuring collaborative care delivery.

The ideal candidate will be a Registered Nurse with experience in case management. Comprehensive benefits and supportive work environment are provided, including educational support and retirement resources.

Qualifications

• Registered Nurse Licensure is required.
• One to three years of experience in a hospital or health care system is needed.
• Knowledge of CMS guidelines is preferred.

Responsibilities

• Perform continuous assessments and evaluations for patient outcomes.
• Coordinate discharge planning process with healthcare team members.
• Manage utilization reviews for appropriateness of care.

Skills

Registered Nurse Licensure

Assertive and persuasive communication skills

Education

Bachelor’s or Master’s of Science in Nursing

Job description

Job Summary and Qualifications

The Case Manager’s primary duties are to provide Utilization Review and Case Management functions for the organization under the direction of the Director, Case Management and within the established policies and procedures. The role performs preadmission, concurrent, and retrospective review for all payers, completes assessments to identify discharge‑planning needs, and provides discharge‑planning services for select patient populations. It requires proficiency in InterQual.

Responsibilities

• Performs continuous assessments and evaluations to ensure patients are progressing toward desired outcomes.
• Assesses and responds to patient/family needs by coordinating efforts of other team members.
• Identifies and resolves barriers that hinder effective patient care.
• Collaborates and consults with physicians on patient’s progress and discharge planning needs.
• Performs utilization review to ensure admissions meet criteria for appropriateness of care and medical necessity.
• Manages the process to review and, as appropriate, appeal denials received from payers.
• Coordinates the discharge planning process, ensuring involvement of all members of the healthcare team.
• Counsels with patients and family members in decision making and in meeting psycho‑social needs of the patient.
• Maintains knowledge of resources and facilities available to patients and family members.
• Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
• Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities.
• Applies knowledge of the patient population served; proves age‑specific care; applies knowledge of expected norms in planning care.
• Promotes internal and external customer satisfaction.
• Builds and promotes a culture of service excellence and continuous improvement.
• Attends work as scheduled and complies with Attendance and Tardiness Policy.

Qualifications

• Required: Registered Nurse Licensure.
• Preferred: Bachelor’s or Master’s of Science in Nursing; knowledge of CMS guidelines and experience working with payer‑specific guidelines and contractual rules; previous UR or hospital Case Management experience.
• One to three years of experience in a hospital or health care system.
• Assertive and persuasive communication skills; action oriented.

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services.
• Well‑being support, including free counseling and referral services.
• Time‑away-from-work programs for paid time off, paid family leave, long‑ and short‑term disability coverage and leaves of absence.
• Savings and retirement resources, including a 401(k) plan with a 100% match on 3% to 9% of pay, Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial well‑being counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.

We are an equal‑opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.