RN Case Manager

Company: Enterprise Solutions Inc
Location: Cambridge
Posted on: June 3, 2025

Job Description:

Primary Responsibilities:1. Performs utilization review and discharge planning to inpatient admissions to MAH.2. Applies InterQual Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient and outpatient care.3. Communicates with attending and house staff when options to inpatient care are identified.4. Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options.5. Works with MAH nursing and social work staff to coordinate and facilitate patient discharge.6. Identifies days not meeting acute hospital level of care criteria and reports them to the physician reviewer.7. Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs.8. Accurately manages observation status patients by working with physicians to ensure appropriate utilization.9. Is part of the department's Saturday, holiday and beeper rotation as needed.10. Adheres to all insurance, contractual, and regulatory requirements as mandated.11. Abides by MACIPA Case Management standards as per the MACIPA CM guidelines.Required Qualifications:1. Bachelor's degree preferred. Current state license as a Registered Nurse2. Three years of medical/surgical nursing care experience. Two years of case management or utilization management experience required.3. Basic computer and typing skills.4. Effective verbal communication skills and problem solving and conflict resolution skills.5. Demonstrated ability to organize and work independently.#RA1Job Type: Full-timePay: $3,000.00 - $3,250.00 per weekBenefits:* 401(k)* 401(k) matching* Dental insurance* Employee discount* Flexible schedule* Health insurance* Life insurance* Paid time off* Relocation assistance* Retirement plan* Tuition reimbursement* Vision insuranceSchedule:* Day shift* Monday to FridayExperience:* Case management: 3 years (Preferred)License/Certification:* BLS Certification (Preferred)* RN MA License (Preferred)Work Location: On the roadby Jobble

Keywords: Enterprise Solutions Inc, Cambridge , RN Case Manager, Executive , Cambridge, Massachusetts