Nantucket Cottage Hospital is hiring a Per Diem RN Case Manager to join our team. In this role, you will be a core member of the care team, responsible for the professional assessment, planning, and coordination that ensures quality patient care, effective use of health services, and compliance with reimbursement and regulatory standards.
What You'll Do
- Provide professional assessment, planning, and coordination of patient care under the guidance of the department manager.
- Review the medical necessity of admissions and continued hospital stays.
- Analyze patient records for compliance with government and insurance reimbursement policies.
- Ensure adherence to insurance, governmental, and accrediting agency standards.
- Submit required data to agencies and determine patient review dates.
- Assist with federally mandated quality assurance reviews.
- Coordinate healthcare within the facility and manage referrals for outside services.
- Provide outreach and enrollment services to meet eligibility requirements.
- Focus on developing and coordinating community service plans.
- Partner with providers, families, and patients to create care plans and identify additional services.
- Modify treatment plans based on patient responses and conditions.
- Prepare patients and families for discharge.
- Communicate with third-party payers to obtain authorization for service reimbursement.
- Consult with medical directors on challenging cases as needed.
- Define patient care goals by providing education, information, and direction.
- Maintain accurate, detailed reports and records.
- Comply with all policies and standards.
What We're Looking For
- Associate's Degree in Nursing
- Active Massachusetts Registered Nurse license
- Basic Life Support certification
Nice to Have
- Bachelor's Degree in Nursing
- 2-3 years of experience in case management, utilization review, or discharge planning
Technical Stack
- Microsoft Office Suite
- Industry-related software programs
Team & Environment
You will be a core member of the interdisciplinary care team, reporting to the department manager.
Benefits & Compensation
- Compensation: $28.20 - $68.49 per hour
- Comprehensive benefits package
- Career advancement opportunities
- Differentials, premiums, and bonuses as applicable
- Employee recognition programs
Work Mode
This is a hybrid position based at our 57 Prospect Street location.
Nantucket Cottage Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.
