Discharge Planning & Care Navigator

Cape Cod Healthcare Inc.; Hyannis (MA); On-site; USD 58,000 - 124,000; Full time

Job summary

Cape Cod Hospital in Hyannis, MA is seeking an experienced Case Manager RN to coordinate patient care, lead discharge planning, and advocate for patients within payer guidelines. You will collaborate with an interdisciplinary team, review care plans, and ensure efficient and high-quality outcomes.

Responsibilities include screening admissions, coordinating follow-ups, handling third-party requests, and ensuring compliance with InterQual criteria while maintaining timely communication with

Qualifications

• Active MA RN license required; BSN preferred.
• Certificate in Case Management or CPUM preferred.
• 3 years acute care experience in past 5 years.
• Experience with discharge planning and utilization review.
• Knowledge of InterQual or equivalent system.
• Strong interpersonal and negotiation skills.
• Excellent organization and time management.
• Ability to work independently in a fast-paced environment.
• Proficient computer skills with updated software.

Responsibilities

• Screen admissions daily for discharge planning needs and set visit priority.
• Verify demographics and payer information; notify corrections.
• Ensure follow-up within 1 business day; reassess every 3 days as needed.
• Review admission and level of care via InterQual criteria.
• Initiate HINN notices and discharge appeal coordination.
• Identify high-risk patients and refer to appropriate resources.
• Support third-party reimbursement with payer requests for information.
• Collaborate with physicians and care team to align plans.
• Participate in unit rounds and advocate for patients with payers.
• Complete transfer papers for safe patient transfers; ensure compliance.
• Apply care maps and pathways; participate in care conferences.
• Monitor length of stay; refer to Physician Advisor when needed.
• Maintain knowledge of regulatory and payer requirements.

Skills

Interpersonal skills

Negotiation skills

Time management

Organization

Independent work

Computer skills

Stress management

Education

Bachelor of Science in Nursing

Registered Nurse license (MA)

Case Management certification (or CPUM)

Tools

InterQual

Job description

Cape Cod Hospital in Hyannis, MA is seeking an experienced Case Manager RN to coordinate patient care, lead discharge planning, and advocate for patients within payer guidelines. You will collaborate with an interdisciplinary team, review care plans, and ensure efficient and high-quality outcomes.

Responsibilities include screening admissions, coordinating follow-ups, handling third-party requests, and ensuring compliance with InterQual criteria while maintaining timely communication with