Registered Nurse Case Manager

Overview

• Provide care coordination and case management services to optimize patient outcomes.
• Collaborate with interdisciplinary teams to ensure seamless care transitions and discharge planning.
• Work on-site during day shifts with rotating weekend schedules.
• Utilize clinical guidelines and critical thinking for effective care progression.
• Engage with patients, families, and insurance providers to address care needs.
• Document case management activities accurately in the Electronic Medical Record (EMR).
• Contribute to utilization management and compliance with regulatory standards.
• Support patients in navigating healthcare resources and addressing social determinants of health.

Key Responsibilities & Duties

• Conduct comprehensive patient assessments to determine care plans and discharge needs.
• Collaborate with interdisciplinary teams to develop and implement post-acute care arrangements.
• Coordinate with insurance providers and community resources for seamless care transitions.
• Partner with Utilization Review teams to ensure appropriate care levels and documentation.
• Identify and address potential delays or inefficiencies in patient care processes.
• Educate patients and families on healthcare options and navigation strategies.
• Facilitate interdisciplinary rounds and family meetings as needed.
• Collaborate with social workers and financial counselors to address patient care barriers.

Job Requirements

• Active RN license in the state of practice.
• BLS certification required for hospital-based roles.
• Minimum 2 years of acute hospital nursing experience.
• Preferred 3 years in care coordination or case management within acute settings.
• BSN degree or equivalent experience preferred.
• Certifications such as CCM, ACM-RN, or UM preferred.
• Proficiency in managed care, payer environments, and CMS regulations.
• Strong critical thinking and decision-making skills.