Job Summary

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.

 

Responsibilities

Accurate medical necessity screening and submission for Physician Advisor review,

Care coordination & Transition planning assessment and reassessment

Implementation or oversight of implementation of the transition plan

Leading and facilitating multi-disciplinary patient care conferences and managing concurrent disputes

Identifying and referring complex patients to Social Work Services

Other duties as assigned

Qualifications

Required:

 

Education: Graduate of an accredited school of nursing

Experience: 2 years of acute hospital patient care experience

Licensure/Certification: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered

Preferred:

Education: Academic degree in nursing (bachelor's or master's)

Experience:  Acute hospital case management experience

Licensure/Certification: Accredited Case Manager (ACM)