Provide telephonic RN case management support for inpatient and emergency department patients, using InterQual or MCG criteria to guide admission and observation status decisions. The work centers on review of ED, observation, and new admit cases, with availability to answer questions from the ER as needed. This role collaborates with hospitalists and tele-UM staff in a flexible, team-based tele-coverage model.
Key Responsibilities
- Guide ED admission decisions using InterQual or MCG criteria and insurance guidelines.
- Review observation patients on the medical floor to determine whether inpatient criteria are met.
- Provide case management support for new admits during assigned coverage shifts.
- Be available to answer clinical questions from the emergency department.
- Collaborate with local hospitalists and tele-UM staff as needed.
- Participate in daily inpatient and ED case review workflows.
Required
- Active RN licensure in multiple states.
- At least 3 years of case management experience in inpatient and emergency department settings.
- At least 3 years of experience using InterQual and MCG.
- Ability to lead the program independently.
Preferred
- Experience working in a tele-coverage or tele-UM environment.
- Experience supporting both AM and PM coverage workflows.
Benefits & Perks
- Part-time schedule with flexible scheduling among the RN case management team.
- Telecoverage model with remote case management work.
- Defined shift coverage windows.
- Pay-per-click compensation after a set number of reviews per shift.