RN-Case Manager
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
- Utilization Review
- Discharge planning
- Readmission Reduction Participation
- Payer Communication and denial reduction
- Completes assigned goals
Specifications
Experience
Minimum Required
- RN with at least (1) year of clinical experience
Preferred/ Desired
- RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
- Diploma or Associate Degree in Nursing
Preferred/ Desired
- BSN or MSN
Training
Minimum Required
Preferred/Desired
- Certified Case Manager
Special Skills
Minimum Required
Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
Minimum Required
RN
Preferred/Desired
RN; CCM; ACM