Job Title: Travel Case Manager – LPN/RN (Emergency Department)
Location: Hyannis, MA 02601
Duration: 13 Weeks
Shift: 11:00 AM – 9:30 PM or 11:30 AM – 10:00 PM
Type: Contract
A leading healthcare facility in Hyannis, MA is seeking an experienced Travel Emergency Department Case Manager (LPN or RN) for a 13-week travel assignment. The Case Manager will play a vital role in ensuring high-quality care coordination, discharge planning, and utilization management for patients within the fast-paced ED environment. This role requires a combination of clinical expertise, strong communication skills, and knowledge of insurance protocols to support positive outcomes and continuity of care.
Key Responsibilities:Clinical Assessment & Planning:
Screen new ED admissions daily for discharge needs
Complete and update InterQual® assessments as required
Determine Inpatient vs. Observation status and validate appropriately
Identify and refer complex psychosocial or financial issues
Utilization Review & Reimbursement:
Conduct reviews to ensure efficient resource use and payer compliance
Interface with insurance providers to secure authorizations and documentation
Issue appropriate payer notices (e.g., HINNs) and assist with appeals
Discharge Planning & Coordination:
Collaborate with interdisciplinary team to develop safe discharge plans
Participate in ED rounds and maintain timely communication
Arrange transfers and referrals, ensuring documentation is complete
Patient Advocacy & Communication:
Act as a liaison for patients and families regarding coverage and care plans
Support patient-centered care and shared decision-making
Documentation & Compliance:
Maintain thorough records in the EHR and according to regulatory standards
Work with coders and documentation specialists to ensure accurate reimbursements
Track and report days at risk for insurance denials
Team Support & Development:
Stay current with case management protocols and payer guidelines
Attend departmental education, meetings, and contribute to quality initiatives
Education:
Graduate of an accredited nursing program (LPN or RN)
Bachelor of Science in Nursing (BSN) preferred
Licensure/Certifications:
Active and unencumbered Massachusetts LPN or RN license
Certification in Case Management (CCM, CPUR, CPUM) preferred
Experience:
3+ years of recent acute care experience in a hospital setting (within past 5 years)
2+ years in case management, discharge planning, and utilization review
Familiarity with InterQual® or comparable utilization review tools
Skills:
Strong written and verbal communication
Excellent organizational and critical thinking skills
Proficient in electronic health records (EHRs) and computer systems
Ability to work effectively in a high-acuity, team-based ED environment
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