RN Care Coordinator: Utilization & Discharge Navigator

Merrimack Health; Methuen (MA); On-site; USD 90,000 - 115,000; Full time

Job summary

Merrimack Health in Massachusetts is seeking a Registered Nurse Care Coordinator to oversee care appropriateness for health plan members and coordinate UM activities. The role supports discharge planning and collaborates with social workers to ensure timely, effective care.

The RN Care Coordinator will rotate through hospital areas, perform utilization reviews, and help reduce revenue denials while maintaining high-quality patient outcomes.

Qualifications

• BSN preferred; Master’s degree preferred (Nursing Masters not required).
• Current Massachusetts Nursing license.
• Minimum 5 years clinical nursing experience.
• 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review preferred.
• Strong verbal and written communications skills.
• Proficiency with computers and an ability to learn new programs with ease.

Responsibilities

• Utilizing InterQual® Level of Care Criteria, ensuring appropriate service assignment (inpatient vs observation) and collaborating with the attending MD to reduce the possibility of reimbursement denials
• Provides clinical information necessary for authorization to 3rd parties within one business day of request
• Communicates excess day and/or denial information to the team; resolves delays by negotiating with the team, ancillary services, 3rd parties
• Rounds with the care team and collaborates with the team to identify patients/families with complex discharge needs. Determines appropriate referrals.
• Ensures patients are discharged appropriately to alternative sites in a timely manner

Skills

Strong communication skills

Clinical nursing experience

Education

BSN preferred

Master’s degree preferred (Nursing Masters not required)

Massachusetts Nursing license

Job description

Merrimack Health in Massachusetts is seeking a Registered Nurse Care Coordinator to oversee care appropriateness for health plan members and coordinate UM activities. The role supports discharge planning and collaborates with social workers to ensure timely, effective care.

The RN Care Coordinator will rotate through hospital areas, perform utilization reviews, and help reduce revenue denials while maintaining high-quality patient outcomes.