Case Manager, Registered Nurse

Position Summary

Maintains continuity of care, optimizes patient outcomes, enhances patient satisfaction, ensures cost efficiency, and promotes regulatory compliance.

Collaborates with the multidisciplinary team, payors, and community resources; leads discharge planning and utilization review activities.

Essential Functions

• Consults regularly with nursing staff and the multidisciplinary team to evaluate patient status and appropriateness of care, including admission, length of stay, transfers, and discharge.
• Maintains patient and family satisfaction; responds to questions and complaints from patients, families, and payors.
• Led and coordinates discharge planning, including patient transfers to other facilities and referrals to community resources; provides discharge education.
• Performs chart reviews to identify and address issues related to service delivery, patient outcomes and satisfaction, compliance, cost, and reimbursement.
• Communicates effectively with providers, payors, and ancillary services to remove barriers and ensure timely care progression.
• Accurately documents case management activities, plans, and outcomes.
• Participates in performance improvement and required continuing education.
• Supports department operations by working alternate shifts/units as needed; may be assigned on-call.

Additional Information

• Patient Populations Served: Neonate, Infant, Early Childhood, Late Childhood, Adolescent, Young Adult, Middle Adult, Older Adult.
• Protected Health Information Accessed: Demographic, Clinical, Insurance, Financial, Complete Medical Record.

Physical Requirements

• Frequent keyboard data entry, sitting, standing, walking, and repetitive hand/arm movements.
• Sometimes kneeling, squatting, pushing/pulling and lifting/carrying up to 25 lbs.
• Rarely climbing or running.

Knowledge, Skills & Abilities

• Education: Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred.
• Licenses/Certifications: Current AL RN license; BCLS required.
• Skills: Critical thinking and decisive judgment; ability to work with minimal supervision in stressful environments. Proficiency learning/navigating multiple clinical software systems. Effective English communication (read, write, speak, and understand).
• Experience: At least 2 years hospital RN experience required. Hospital case management preferred. Critical Care Experience, ER Experience, Post acute agencies work (home health, hospice, SNF rehab, etc.) or other relative work experience considered.