RN Case Manager: Care Transitions & Utilization Review

Heywood Hospital; Gardner (MA); On-site; USD 108,886,000 - 226,166,000; Full time

Job summary

Heywood Hospital in Massachusetts is seeking a Care Coordinator to manage utilization reviews, care transitions, and payer communications within a multidisciplinary team.

The role requires BSN preferred, InterQual and Meditech Expanse experience, and strong communication and multitasking abilities. You will perform daily UR duties, document in EMR, and support timely admissions and discharge planning.

Qualifications

• Minimum Education: BSN preferred.
• Minimum Work Experience: UR/QA experience; 2 years healthcare experience in Acute Care/SNF/HHA/Insurance preferred.
• Required Skills: InterQual experience, Meditech Expanse experience, proficient computer skills, strong written/verbal/interpersonal communication, critical thinking, multitasking and flexibility, discharge planning experience.

Responsibilities

• Utilization Management reviews and care transitions coordination with payers.
• Assess admissions within 24 hours against screening criteria and document outcomes.
• Complete re-admission assessments within 30 days and report findings.
• Educate providers on InterQual Criteria and status changes.
• Perform daily utilization reviews for medical/psychiatric appropriateness.
• Collaborate with care teams to determine level of care and discharge planning.

Skills

InterQual experience

Discharge planning

Communication skills

Critical thinking

Multitasking

Denials/Appeals knowledge

Care coordination

Education

BSN preferred

Tools

Meditech Expanse

InterQual criteria

Job description

Heywood Hospital in Massachusetts is seeking a Care Coordinator to manage utilization reviews, care transitions, and payer communications within a multidisciplinary team.

The role requires BSN preferred, InterQual and Meditech Expanse experience, and strong communication and multitasking abilities. You will perform daily UR duties, document in EMR, and support timely admissions and discharge planning.