RN Case Manager: Care Coordination & Discharge Advocate

South Shore Health; Randolph (MA); On-site; USD 85,000 - 110,000; Full time

Job summary

South Shore Health is seeking an RN Case Manager to ensure appropriate utilization, discharge planning, and care coordination for complex patients. The role requires reviewing observations and admissions, applying InterQual criteria, and communicating with physicians and payers.

The on-site position involves a seven-day-a-week schedule with weekend rotations and occasional holidays. The RN Case Manager will collaborate with interdisciplinary teams to optimize patient outcomes, manage resources,

Qualifications

• RN with current license and hospital experience.
• 3-5 years acute care hospital experience preferred.
• CCM or ACM certification within two years of hire preferred.
• Negotiation, communication, and critical thinking skills required.

Responsibilities

• Review medical records to ensure appropriate utilization and care.
• Coordinate discharge planning and post-acute referrals.
• Consult with physicians, nursing, and payor for status determinations.
• Communicate with patients and families about care plans and options.
• Maintain up-to-date knowledge of payer requirements and resources.

Skills

Care coordination

Discharge planning

InterQual criteria

Case management

Education

RN - Registered Nurse

Tools

EHR

InterQual

MCCM

Epic

Job description

South Shore Health is seeking an RN Case Manager to ensure appropriate utilization, discharge planning, and care coordination for complex patients. The role requires reviewing observations and admissions, applying InterQual criteria, and communicating with physicians and payers.

The on-site position involves a seven-day-a-week schedule with weekend rotations and occasional holidays. The RN Case Manager will collaborate with interdisciplinary teams to optimize patient outcomes, manage resources,