Registered Nurse (RN) Case Manager

Stellar Health Group; Winchester (MA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Long-term disability insurance

Short-term disability insurance

Paid time off for full-time employees

Six paid holidays

401(k)

Complimentary employee meals

Job summary

Winchester Rehabilitation and Nursing Center in Winchester, MA is seeking a dedicated Registered Nurse (RN) Case Manager to coordinate resident care and drive optimal outcomes. You will work closely with the Director of Nursing, manage authorizations, and engage with an interdisciplinary team to support residents and families throughout the care journey.

The ideal candidate has 5+ years in geriatric nursing, subacute rehab experience, and MA RN licensure, with strong clinical assessment and

Qualifications

• Current, active Massachusetts RN license.
• Minimum 5 years of nursing experience in geriatrics.
• Previous subacute rehabilitation experience required.
• Knowledge of Medicare, Medicaid, PPS, PDPM, MDS, and third-party reimbursement.
• Previous case management experience preferred.
• Strong clinical assessment, communication, and organizational skills.

Responsibilities

• Monitor level of care for HMO patients upon admission and during stay.
• Obtain prior authorizations for transportation, therapy, equipment, and services.
• Track Medicare and HMO days to ensure accurate billing and reimbursement.
• Obtain pre-authorizations for specialized services and equipment as needed.
• Collaborate with physicians, therapists, nurses, and other professionals to develop resident care plans.
• Participate in interdisciplinary team meetings.
• Attend family meetings to provide updates and maintain open communication.
• Ensure compliance with Medicare, Medicaid, PPS, PDPM, MDS, and regulatory requirements.
• Support positive clinical and financial outcomes for residents.

Skills

Clinical assessment

Communication

Organizational skills

Education

Massachusetts RN license

Job description

Registered Nurse (RN) Case Manager

Winchester Rehabilitation and Nursing Center | Winchester, MA

About The Role

Winchester Rehabilitation and Nursing Center is seeking a compassionate and experienced Registered Nurse (RN) Case Manager to join our team.

The RN Case Manager is responsible for coordinating resident care, managing insurance authorizations, monitoring Medicare and HMO utilization, and collaborating with the interdisciplinary team to ensure high-quality clinical outcomes. This position works closely with the Director of Nursing and plays an essential role in supporting both residents and their families throughout the care process.

Registered Nurse (RN) Case Manager Responsibilities

• Monitor the level of care for HMO patients upon admission and throughout their stay.
• Obtain prior authorizations for transportation, therapy, medical equipment, and other services.
• Track Medicare and HMO days to ensure accurate billing and reimbursement.
• Obtain pre-authorizations for specialized services and equipment as needed.
• Collaborate with physicians, therapists, nurses, and other healthcare professionals to develop and implement resident care plans.
• Participate in interdisciplinary team meetings.
• Attend family meetings to provide updates and maintain open communication.
• Ensure compliance with Medicare, Medicaid, PPS, PDPM, MDS, and regulatory requirements.
• Support positive clinical and financial outcomes for residents.

Qualifications

• Current, active, and unrestricted Massachusetts Registered Nurse (RN) license.
• Minimum of 5 years of nursing experience in geriatrics.
• Previous subacute rehabilitation experience required.
• Knowledge of Medicare, Medicaid, PPS, PDPM, MDS, and third-party reimbursement.
• Previous case management experience preferred.
• Strong clinical assessment, communication, and organizational skills.
• Ability to work effectively within an interdisciplinary team.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Long-term disability insurance
• Short-term disability insurance
• Paid time off for full-time employees
• Six paid holidays
• 401(k)
• Complimentary employee meals