Full employer posting
Job Overview We are seeking an experienced Case Manager to coordinate patient care, support appropriate discharge planning, and ensure medical necessity and regulatory compliance throughout the hospital stay. The ideal candidate will have strong clinical judgment, utilization review knowledge, and previous travel assignment experience. Responsibilities Assess patients' needs and coordinate appropriate discharge plans and post-acute services.
Collaborate with physicians, nursing staff, insurers, patients, and families to support continuity of care. Monitor patient progress and length of stay, identifying barriers to timely discharge. Evaluate admission and continued-stay medical necessity using InterQual and/or Milliman Care Guidelines.
Perform utilization review, concurrent review, continued-stay review, retrospective review, and appeals or denials activities as applicable. Follow Medicare requirements related to patient choice, IMM notices, and MOON notices. Maintain accurate documentation and comply with CMS, HIPAA, and applicable healthcare regulations.
Float within the facility and scope of practice as required. Requirements Minimum 3 years of relevant Case Management experience. Previous travel assignment experience; first-time travelers are not accepted.
Experience with discharge planning, care coordination, utilization review, and medical necessity. Familiarity with InterQual or Milliman Care Guidelines. Knowledge of Medicare regulations and hospital compliance requirements.
Required license and credentials to be confirmed with the facility. Schedule and Contract Details Monday–Friday schedule with no weekend or on-call requirements. Up to 7 days of requested time off, subject to discussion during the interview and manager approval.
Major holiday coverage is required according to the contract period. Full compliance must be completed before the scheduled start date. Incomplete compliance may delay the start by two weeks due to the biweekly orientation schedule.
Non-billable orientation hours depend on contract length; for example, 8 hours for an 8-week assignment or 10 hours for a 10-week assignment.