RN Case Manager: Care Transitions & Utilization Review

Sturdy Memorial Hospital; Attleboro (MA); On-site; USD 87,000 - 135,000; Part time

Benefits offered by this job

Sign-on bonus eligible

Job summary

Sturdy Memorial Hospital in Attleboro, MA is seeking an RN Case Manager to coordinate patient progression through the continuum of care. The role focuses on utilization review, discharge planning, and effective communication with families, physicians, and the care team.

Requirements include 3–5 years of acute care case management, Massachusetts RN license, and CCM/ACMA preferred. Sign-on bonus eligible; ability to work with diverse stakeholders and documentation in EHRs is essential.

Qualifications

• Minimum 3-5 years acute care case management experience, with demonstrated skills in utilization review.
• Demonstrated ability to use critical thinking and problem solving skills in facilitating safe and timely patient transitions of care.
• Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum.
• Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation.
• Ability to garner and utilize information effectively to develop and modify patient plan of care.
• Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment.
• Ability to successfully utilize industry accepted utilization and or medical management criteria in patient status decision making.
• Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals.
• Excellent computer skills to accurately document requisite information to support patient status and medical necessity

Responsibilities

• Collaborate with patient/family/legal representative, social workers, physicians and interdisciplinary team to assess and coordinate care.
• Assess pre-admission level of care and post-discharge needs to facilitate safe transitions.
• Review available resources and communicate with the healthcare team to support patient status decisions.
• Document and track patient status and medical necessity in the electronic health record.
• Advocate for patient needs and participate in meetings with hospital leaders and clinicians.

Skills

Utilization review

Critical thinking

Communication skills

CMS/Medicaid knowledge

Discharge planning

Data/documentation

Electronic health record

Independent work

Analytical ability

Problem solving

Education

RN license Massachusetts

ASN

BSN/MSN preferred

Tools

Meditech

Cerner

Denials management

Job description

Sturdy Memorial Hospital in Attleboro, MA is seeking an RN Case Manager to coordinate patient progression through the continuum of care. The role focuses on utilization review, discharge planning, and effective communication with families, physicians, and the care team.

Requirements include 3–5 years of acute care case management, Massachusetts RN license, and CCM/ACMA preferred. Sign-on bonus eligible; ability to work with diverse stakeholders and documentation in EHRs is essential.