RN Case Manager: Discharge & Care Coordination

South Shore Health System; United States; On-site; USD 118,000 - 171,000; Full time

Job summary

South Shore Health is seeking an RN Case Manager to coordinate, negotiate, procure services, and manage care for complex patients to achieve quality and cost-efficient outcomes. The role requires on-site presence, weekend rotation, and occasional holidays, with coverage seven days a week as needed.

The RN Case Manager will review records for medical necessity, assess admission status, and facilitate safe transitions of care across the SSH/EC continuum, collaborating with physicians, nurses, and

Qualifications

• RN license required or preferred; BSN strongly preferred.
• 3–5 years of acute care hospital experience preferred.

Responsibilities

• Review the medical records for observation and inpatient admissions to ensure appropriate utilization and care.
• Identify cases daily that do not meet criteria and refer to manager/physician advisor for review.
• Contact attending physicians daily to clarify documentation needed to support medical necessity.
• Coordinate discharge planning and referrals to ensure timely, safe transitions of care.
• Communicate with payers and care teams to optimize resources and avoid delays.

Skills

Case management

Care coordination

Discharge planning

Medical necessity review

InterQual criteria

Education

RN license (Massachusetts)

Bachelor's degree in Nursing

Tools

InterQual

EHR/EPIC

Job description

South Shore Health is seeking an RN Case Manager to coordinate, negotiate, procure services, and manage care for complex patients to achieve quality and cost-efficient outcomes. The role requires on-site presence, weekend rotation, and occasional holidays, with coverage seven days a week as needed.

The RN Case Manager will review records for medical necessity, assess admission status, and facilitate safe transitions of care across the SSH/EC continuum, collaborating with physicians, nurses, and