Case Management RN

Purpose of Position: The Case Manager is responsible for the facilitation and coordination of patient care for a specific patient population or area of assignment.

• Screen new admissions for discharge planning needs.
• Establish visit priorities based on screening criteria.
• Verify the accuracy of demographics and payer information.
• Conduct patient assessments using established standards and clinical guidelines.
• Collaborate with third-party representatives to facilitate patient care needs.
• Review patient admission and level of care using appropriate criteria.
• Handle patient appeal rights under the Discharge Appeals program.
• Identify and refer patients with high-risk complex psychosocial, financial, and legal needs.
• Conduct utilization review on the assigned unit.
• Respond to third-party payer requests for concurrent clinical information.
• Collaborate with attending physicians and the interdisciplinary team to ensure appropriate care and services.
• Ensure the interdisciplinary care plan aligns with patient needs.
• Participate in daily unit rounds.
• Advocate for patients through partnerships with families, payers, and healthcare teams.
• Assist patient independence in decision-making when appropriate.
• Facilitate thorough referrals for patient transfers.
• Demonstrate knowledge of community resources for effective post-hospital care.
• Participate in the development and revision of clinical pathways.
• Refer cases to Physician Advisor as needed.
• Collaborate with medical coders for appropriate reimbursement.
• Maintain departmental policies, quality assurance, and infection control standards.
• Stay current with regulatory and payer requirements.
• Participate in education programs and meetings.
• Display flexibility and cooperation while fulfilling duties.
• Provide service excellence to all patients, family members, and coworkers.

• Minimum of 3 years acute care experience in a hospital or case management setting within the last 5 years.
• Working knowledge of InterQual, or equivalent system.
• Recent experience in Discharge Planning and Utilization review within the past 4 years.
• Ability to read, write, and communicate in English.
• Bachelor of Science Degree in Nursing preferred.
• Certificate in Case Management or specialty preferred.
• Strong interpersonal and negotiation skills.
• Excellent organization and time management skills.
• Ability to work independently and handle multiple projects effectively.
• Proficient computer skills with the ability to integrate updated software systems.

Must Have

• Acute Care
• InterQual

Trusted Nurse Staffing Benefits We provide reliable, experienced support finding work, securing training, and succeeding in your assignment. Your Trusted team member will customize your pay package and benefits to fit your lifestyle. Benefits include:

• Comprehensive Dental, Health, & Vision Benefits
• HRA Card to Fully Cover Healthcare Deductibles
• Student Loan Assistance Program
• Earn $1,500 for Every Referral
• Retirement & Disability Plans Including 401(k) After One Year
• License, Certification, & CEU Reimbursement

Additional

• Flexible Contracts
• Customized Pay Packages
• Welcome Gift Box
• Weekly Paychecks and Direct Deposit
• Whole Life and Accident Insurance