RN Case Manager

Overview

• Provide critical care coordination and case management services in an acute hospital setting.
• Collaborate with interdisciplinary teams to ensure seamless patient transitions and optimal resource utilization.
• Facilitate discharge planning and post-acute care arrangements for patients.
• Work closely with insurance providers to secure necessary authorizations and manage care plans.
• Ensure compliance with hospital policies, regulatory standards, and evidence-based guidelines.
• Contribute to reducing readmissions and enhancing patient outcomes through effective care coordination.
• Operate within a fast-paced environment, leveraging critical thinking and problem-solving skills.
• Document case management activities accurately in the Electronic Medical Record (EMR).

Key Responsibilities & Duties

• Conduct comprehensive patient assessments to determine care plans and discharge needs.
• Collaborate with patients, families, and interdisciplinary teams to implement discharge plans.
• Assist in removing barriers to timely discharge and securing payer authorizations.
• Partner with Utilization Review teams to ensure appropriate level of care and documentation.
• Educate patients and families on healthcare navigation strategies and available resources.
• Facilitate interdisciplinary rounds, family meetings, and care conferences as needed.
• Maintain knowledge of managed care, payer environments, and CMS regulations.
• Collaborate with social workers and community partners to address social determinants of health.

Job Requirements

• Active RN license in the applicable state(s).
• BLS certification required for hospital-based roles.
• Minimum 2 years of acute hospital nursing experience.
• Experience in Care Coordination, Case Management, or Utilization Management preferred.
• BSN degree or equivalent experience preferred.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM-RN) certification preferred.
• Proficiency in prioritization, delegation, and time management.
• Knowledge of managed care, payer environments, and CMS regulations.