Registered Nurse Case Manager

Portsmouth Regional Hospital - New Hampshire; Portsmouth (NH); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

401(k) match

Tuition assistance

Career mentorship

Employee wellness programs

Certification support

Job summary

Portsmouth Regional Hospital in New Hampshire seeks a dedicated Case Manager to lead utilization review and discharge planning within our multidisciplinary team. You will review admissions, coordinate patient care, and advocate for effective transitions from admission to discharge while collaborating with physicians and care staff.

The role requires RN licensure with preferred BSN/MSN and experience in a hospital setting; strong communication and conflict resolution skills are essential to

Qualifications

• RN licensure is required.
• BSN or MSN preferred; CMS guidelines knowledge and payer guidelines experience.
• 1–3 years hospital or health care system experience.

Responsibilities

• Performs continuous assessments and evaluations to ensure patient progress toward outcomes.
• Coordinate care by addressing patient/family needs and collaborating with the team.
• Identify and resolve barriers hindering patient care.
• Consult with physicians on patient progress and discharge planning.
• Perform utilization review to ensure admissions meet criteria and medical necessity.
• Coordinate the discharge planning process with the healthcare team.
• Counsels patients and family in decision making and psychosocial needs.

Skills

Interqual proficiency

Assertive communication

Collaboration with physicians

Education

Registered Nurse Licensure

BSN/MSN preferred

Job description

Ready for a role that supports your unique calling in patient care and fits your life? At Portsmouth Regional Hospital, you’ll find clear pathways to advance backed by our unmatched nationwide transfer policy that lets you grow your career when the time is right for you. With mentorship opportunities, clinical education courses, professional certification support, and educational assistance, you will have all the resources you need to build the career of a lifetime.

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. He/she performs preadmission, concurrent and retrospective review for all payers; completes assessments for the purpose of identifying discharge-planning needs; and provides discharge-planning services for select patient populations. Must be proficient in Interqual. The Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge.

v Your responsibilities will include:

• Performs continuous assessments and evaluations to ensure patient is progressing towards 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 ensuring 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
• Attendance: works as scheduled and is compliant with Attendance and Tardiness Policy

What qualifications you will need

• Required: Registered Nurse Licensure
• Preferred: Bachelors or Masters 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

Portsmouth Regional Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing 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 (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing 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

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

At Portsmouth Regional Hospital, you're not just joining a hospital—you’re becoming part of a mission‑driven team that’s redefining healthcare excellence across the Seacoast region

As a 240‑bed acute care facility in Portsmouth, NH, we proudly serve communities throughout New Hampshire, Maine, and Massachusetts. We’re the only hospital in the area to be recognized as an ACS Verified Level II Trauma Center and a Comprehensive Stroke Center, and we offer a robust heart and vascular program—giving our team the opportunity to work at the forefront of life‑saving care.

As part of the HCA Healthcare family, you’ll be supported by one of the nation’s leading healthcare systems, with a strong presence in New Hampshire that includes four hospitals, three freestanding emergency rooms, and over 70 care sites.

Here, nearly 5,000 colleagues—including 1,500 nurses and 1,000 affiliated physicians—collaborate to deliver exceptional care and innovation every day. Whether you're at Portsmouth, Catholic Medical Center in Manchester, Parkland Medical Center in Derry, Frisbie Memorial Hospital in Rochester, or one of our emergency facilities in Seabrook, Dover, or Plaistow, you’ll find a culture that values your expertise, supports your growth, and empowers you to make a real difference.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“Nurses are essential to the delivery of healthcare and serve as its foundation. At HCA Healthcare, we are committed to equipping nurses with the tools and resources they need to deliver exceptional patient care, championing the profession, and supporting the advancement of nursing’s future.”

Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC

Senior Vice President and Chief Nurse Executive

HCA Healthcaret

Join a family that cares about every stage in your career!

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.