RN
- Case Management / Utilization Review
- RNRR NavitasPartners
- 4.
0 Fall River, MA Job Details Full-time 2 hours ago Qualifications Utilization review RN License Health education for healthcare providers Program development CMS Social service program staff supervision Clinical staff development programs Windows Managing patients as a nurse case manager Team development Transitional care planning in clinical case management Continuing education (CE) programs (healthcare teaching and curriculum development) Acute care facility experience CMS regulatory compliance Case care planning Medicare regulations Utilization management Bachelor of Science in Nursing Resource utilization in healthcare Bachelor's degree in nursing Computer skills Operational excellence initiatives Care coordination Hospital regulatory compliance Educational program management Full Job Description Registered Nurse (RN)
Utilization Review Location:
Hyannis, MA 02601
Duration:
27
Weeks Shift:
Day Shift Hours:
40
Hours Per Week Schedule:
Monday
Hour Shifts On-Call:
Rotating Weekend and Holiday Coverage Required We are seeking an experienced Registered Nurse (RN) with a strong background in Case Management, Utilization Review, and Care Coordination for a long-term assignment in Hyannis, Massachusetts. This leadership-focused role is responsible for overseeing case management operations, supporting utilization review activities, facilitating discharge planning, and promoting quality patient outcomes within an acute care environment.
Requirements:
Active Massachusetts Registered Nurse (RN) License required. Bachelor of Science in Nursing (BSN) required. Minimum 5 years of acute care Case Management experience required. Minimum 3 years of recent acute care hospital experience within the last 5 years required. Working knowledge of InterQual® or equivalent utilization review system. Strong knowledge of discharge planning, utilization management, and care coordination. Experience with process improvement initiatives. Experience developing and presenting professional education programs. Knowledge of CMS regulations. Strong computer proficiency and familiarity with Windows-based systems. Excellent leadership, communication, analytical, and organizational skills.
Preferred Qualifications:
Master's Degree in Nursing or related healthcare field. Case Management Certification (CCM, ACM) preferred. Clinical Documentation Integrity certification preferred. Previous management or supervisory experience. Experience leading multidisciplinary teams.
Responsibilities:
Oversee daily operations of Case Management, Utilization Review, and Social Work services. Manage staff scheduling, workflow coordination, evaluations, and team development. Support Clinical Documentation Improvement (CDI) initiatives. Conduct patient care rounds to identify discharge barriers and facilitate care transitions. Develop and deliver educational programs for healthcare professionals. Monitor departmental performance metrics and regulatory compliance. Create and maintain operational and quality performance dashboards. Identify process improvement opportunities and implement corrective action plans. Mentor and coach interdisciplinary teams to improve collaboration and patient outcomes. Analyze program data and departmental performance trends. Ensure compliance with CMS regulations and industry best practices. Promote a culture of continuous improvement and operational excellence. For more details contact at or Call / Text at 516-862-1169 .
About Navitas Healthcare, LLC:
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.
