RN, Acute Care Case Manager - Full Time

Southern New Hampshire Health; Nashua (NH); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

Tuition reimbursement

Job summary

Southern New Hampshire Health is seeking an experienced RN Acute Care Case Manager to evaluate patients, coordinate discharge planning, and manage utilization and regulatory requirements to ensure safe, efficient transitions.

You will collaborate with physicians, nurses, social workers and community resources to optimize outcomes while ensuring compliance with standards. Bachelor’s in Nursing and NH RN licensure are required; Case Manager certification preferred.

Qualifications

• Bachelor’s degree in Nursing
• Current RN licensure in New Hampshire
• Case Manager Certification preferred
• Minimum of 3–5 years of case management-related healthcare experience
• Seven years of experience may substitute for the degree
• Experience with InterQual, MCG, Milliman, or other criteria preferred
• Acute care utilization review and/or discharge planning experience preferred
• Knowledge of care coordination principles and practices
• Excellent written and verbal communication skills
• Proficiency with Microsoft Office applications
• Strong analytical thinking and critical decision-making abilities
• Ability to manage competing priorities in a fast-paced healthcare environment
• Ability to collaborate effectively across interdisciplinary teams
• Ability to achieve competency in abuse reporting, guardianship, discharge planning and case coordination, utilization review

Responsibilities

• Evaluate patient health status, caregiver capabilities, and support systems to facilitate discharge planning.
• Develop and coordinate multidisciplinary discharge plans that support safe transitions of care.
• Perform utilization review activities and determine appropriate levels of care using InterQual criteria.
• Conduct concurrent clinical reviews and communicate with insurance providers to support authorization and prevent denials.
• Review medical records to assess medical necessity and utilization of services throughout the patient stay.
• Coordinate patient-centered discharge planning meetings with the care team.
• Participate in interdisciplinary care planning and patient-care team huddles.
• Ensure patients and families receive appropriate post-discharge resources and have choice in agency or facility selection.
• Collaborate with physicians, nurses, therapists, social workers, and community agencies to improve care coordination.
• Mobilize resources to achieve clinical outcomes within desired timeframes.
• Serve as a resource regarding utilization review processes and support appeals as needed.
• Ensure compliance with discharge planning regulations and standards.
• Issue Important Messages from Medicare within required timeframes.
• Participate in quality improvement and performance improvement initiatives.
• Maintain confidentiality and protect patient privacy.
• Perform other duties as assigned.

Skills

Excellent written and verbal

Strong analytical thinking

Critical decision-making

Prioritize in fast-paced env

Collaborate across teams

Care coordination principles

Abuse reporting

Guardianship

Discharge planning

Utilization review

Education

Bachelor’s degree in Nursing

RN licensure in New Hampshire

Case Manager Certification preferred

Tools

InterQual criteria

MCG criteria

Milliman criteria

Microsoft Office

Job description

Who We Are

Southern New Hampshire Health has been a cornerstone of the region since 1893, delivering high-quality, compassionate care close to home. Anchored by Southern New Hampshire Medical Center, a 188-bed, DNV-accredited hospital in downtown Nashua with a Level III-N trauma center, Level II Special Care Nursery, and Magnet® designation for nursing excellence, we offer a full spectrum of services from primary care to advanced diagnostics and specialized treatments. Our medical staff includes over 500 providers from Foundation Medical Partners and local practices. Foundation Medical Partners, our multi-specialty group, spans 70+ practices across southern New Hampshire and northern Massachusetts, providing coordinated, patient-centered care to thousands each year.

About the Job

The RN Acute Care Case Manager evaluates patients’ health status, support systems, and care needs to facilitate safe and effective discharge planning. This role develops multidisciplinary, culturally appropriate, and age-specific discharge plans while managing utilization review processes, determining appropriate levels of care, and coordinating care transitions. The RN Acute Care Case Manager works collaboratively with physicians, clinical staff, patients, families, and community resources to optimize patient outcomes and ensure compliance with regulatory and insurance requirements.

What You’ll Do

• Evaluate patient health status, caregiver capabilities, and support systems to facilitate discharge planning.

• Develop and coordinate multidisciplinary discharge plans that support safe transitions of care.

• Perform utilization review activities and determine appropriate levels of care using InterQual criteria.

• Conduct concurrent clinical reviews and communicate with insurance providers to support authorization and prevent denials.

• Review medical records to assess medical necessity and utilization of services throughout the patient stay.

• Coordinate patient-centered discharge planning meetings with the care team.

• Participate in interdisciplinary care planning and patient-care team huddles.

• Ensure patients and families receive appropriate post-discharge resources and have choice in agency or facility selection.

• Collaborate with physicians, nurses, therapists, social workers, and community agencies to improve care coordination.

• Mobilize resources to achieve clinical outcomes within desired timeframes.

• Serve as a resource regarding utilization review processes and support appeals as needed.

• Ensure compliance with discharge planning regulations and standards.

• Issue Important Messages from Medicare within required timeframes.

• Participate in quality improvement and performance improvement initiatives.

• Maintain confidentiality and protect patient privacy.

• Perform other duties as assigned.

Who You Are / Requirements

• Bachelor’s degree in Nursing

• Current Registered Nurse (RN) licensure in the State of New Hampshire required.

• Case Manager Certification preferred.

• Minimum of 3-5 years of case management-related healthcare experience required.

• Seven (7) years of case management-related healthcare experience may be substituted for the bachelor’s degree requirement.

• Experience with InterQual, MCG, Milliman, or other healthcare acute care criteria preferred.

• Acute care utilization review and/or discharge planning experience preferred.

• Knowledge of care coordination principles and practices.

• Excellent written and verbal communication skills.

• Proficiency with Microsoft Office applications.

• Strong analytical thinking and critical decision-making abilities.

• Ability to manage competing priorities in a fast-paced healthcare environment.

• Ability to collaborate effectively across interdisciplinary teams.

• Ability to achieve competency in:

  • Abuse reporting

  • Guardianship

  • Discharge planning and case coordination

  • Community resource referrals

  • Utilization review

Why You’ll Love Us

• Southern NH Medical Center is a 5-time Magnet designated hospital

• Health, dental, prescription, and vision coverage for full-time & part-time employees

• Medical, dental, and vision coverage

• Life insurance

• Short- and long-term disability

• Flexible Spending Accounts (FSA)

• Competitive pay

• Tuition Reimbursement

• Nursing Student Loan Paydown Program

• 403(b) Retirement Savings Plan

• Education & Paid training courses for continued career progression

• & So much more!