RN Case Manager: Care Coordination & Discharge Lead

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

Job summary

South Shore Health is seeking an experienced RN Case Manager to oversee case management, discharge planning, and care coordination for complex patients. You will work closely with physicians, nursing staff, and payers to ensure appropriate utilization and timely transitions across the continuum of care.

Key responsibilities include reviewing records for medical necessity, coordinating services, and advocating for patients to improve outcomes while containing costs.

Qualifications

• Minimum education: RN; BSN preferred.
• 3–5 years acute care hospital experience; CCU/ED desirable.
• Active RN license; CCM/ACM certification within 2 years of hire preferred.
• Knowledge of utilization management and post-acute care resources.

Responsibilities

• Review medical records of observation and inpatient admissions to ensure appropriate utilization.
• Coordinate discharge planning and care coordination for complex patients.
• Identify cases not meeting criteria and refer for secondary review.
• Communicate with physicians to clarify documentation for medical necessity.
• Assist in obtaining insurance coverage and guidance on benefits.
• Monitor patient status and advocate for timely, appropriate level of care.
• Collaborate with multidisciplinary team to optimize care and resource use.
• Provide data for quality improvement and payer communication.
• Assist physicians and staff in arranging post-acute services (SNF/VNA/Home care).
• Document care plans, referrals, and discharge outcomes.
• Support transitions across the continuum of care and ensure smooth handoffs.
• Participate in team conferences and care rounds to align goals.
• Ensure compliance with department policies and regulatory requirements.

Skills

Negotiation

Communication

Interdisciplinary collaboration

Management

Critical thinking

Time management

Multitasking

Education

Registered Nurse license

BSN preferred

CCM/ACM certification within 2 years

Tools

InterQual

EHR

Epic

Workday

Job description

South Shore Health is seeking an experienced RN Case Manager to oversee case management, discharge planning, and care coordination for complex patients. You will work closely with physicians, nursing staff, and payers to ensure appropriate utilization and timely transitions across the continuum of care.

Key responsibilities include reviewing records for medical necessity, coordinating services, and advocating for patients to improve outcomes while containing costs.