RN Case Manager - ED: Discharge & Care Navigator

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

Job summary

South Shore Health System is seeking a dedicated RN Case Manager to advocate for SSH&EC clients, coordinate services, and manage care for complex patients, aiming for quality outcomes and cost efficiency. The role involves discharge planning, utilization review, and collaboration with interdisciplinary teams.

Under general supervision, you review admissions and stays using InterQual criteria, communicate with physicians and payers, and help identify resources across the continuum of care.

Qualifications

• RN Case Manager must review medical records for observation and inpatient admissions.
• Using InterQual criteria and payor guidelines to determine medical necessity.
• Coordinate discharge planning and care coordination to ensure cost-effective care.
• Identify and review observation patients for correct level of care daily.
• Communicate with physicians, payers, and care teams to facilitate timely discharge.
• Ensure timely notification of changes in patient status to payers and families.

Responsibilities

• Review medical records for admission and continued stay.
• Identify cases not meeting criteria and refer for secondary review.
• Coordinate discharge planning with physicians and care teams.
• Assist with timely notification of coverage changes and approvals.
• Collaborate with payers, patients and families to optimize care transitions.

Skills

InterQual Criteria

Communication

Negotiation

Discharge planning

Critical thinking

Time management

Care coordination

Documentation

Clinical knowledge

Patient advocacy

Education

Registered Nurse

Bachelor's degree preferred

Tools

EHR systems

InterQual

Epic

Workday

MCCM

Job description

South Shore Health System is seeking a dedicated RN Case Manager to advocate for SSH&EC clients, coordinate services, and manage care for complex patients, aiming for quality outcomes and cost efficiency. The role involves discharge planning, utilization review, and collaboration with interdisciplinary teams.

Under general supervision, you review admissions and stays using InterQual criteria, communicate with physicians and payers, and help identify resources across the continuum of care.