When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Inpatient Case Manager (RN) – Utilization Review & Discharge Planning
📍 Burlington, MA
🏥 Lahey Clinic | Acute Care Hospital Setting
Lahey Clinic is seeking an experienced Inpatient Case Manager (Registered Nurse) to support high quality, patient centered care for inpatient admissions. This role is ideal for an RN with strong experience in medical surgical nursing, utilization review, care coordination, and discharge planning within an acute care hospital environment.
As an Inpatient Case Manager, you will partner with physicians, nursing teams, social work, post acute providers, and community case managers to ensure appropriate levels of care, timely transitions, and optimal patient outcomes.
Job Description:
Key Responsibilities | What You’ll Do
Clinical Case Management & Utilization Review
- Perform utilization review and discharge planning for inpatient admissions
- Apply InterQual, AEP, and other approved clinical criteria to determine appropriate inpatient, outpatient, and observation status
- Use clinical expertise to recommend appropriate level of care and alternative treatment settings
- Work closely with physicians to ensure accurate and compliant patient status determination
Care Coordination & Discharge Planning
- Lead multidisciplinary care teams to support timely discharge and patient flow
- Collaborate with Community Case Managers for medically fragile and high‑risk patients
- Partner with Nursing, Social Work, and Post‑Acute Care Coordinators to facilitate timely access to post‑acute services
- Work directly with patients and families to develop safe, effective post‑hospital care plans
Quality, Compliance & Risk Management
- Identify delay days and report to leadership
- Report serious occurrences and sentinel events to Risk Management
- Support utilization management, quality improvement, and clinical pathway initiatives
- Adhere to insurance, contractual, regulatory, and accreditation requirements
Operational & Departmental Support
- Participate in weekend, holiday, and on‑call rotations as needed
- Serve on hospital and medical committees related to case management, utilization review, CQI, and patient advocacy
- Participate in mandatory education, department initiatives, and continuous quality improvement activities
- Demonstrate professional behavior, strong customer service, and collaboration across all levels of care
Minimum Qualifications
Education
- Registered Nurse, Bachelors Degree or commensurate experience preferred
Licensure, Certification, Registration
- Must hold current Commonwealth of Massachusetts license as a Registered Nurse, and Basic Life Support (BLS)
Skills, Knowledge & Abilities
In the absence of any of these skills, demonstrates the ability to be thoroughly trained to Proven leadership and project management experience and skill meet organizational standards.
- Effective verbal communication, problem solving and conflict resolution skills
- Basic computer and typing skills
- Basic knowledge of Quality Improvement techniques
- Demonstrated ability to organize and work independently
Experience
- A minimum of three years of medical/surgical nursing care experience
- Two years of case management or utilization management experience desirable
- Demonstrated ability to communicate effectively with medical and hospital staffs
Pay Range:
$38.11 – $98.23
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
