Case Manager - RN

We are seeking a full-time Case Manager (RN) with a strong background in acute care hospital or related settings, including utilization review or case management experience. The role involves performing chart reviews for admission, concurrent, and retrospective cases to ensure documentation accuracy, appropriate stay, and reduce denial risks. Responsibilities include collaborating with payers and healthcare teams to manage patient progression, discharge planning, and resource utilization. The case manager works closely with social workers and discharge planners to facilitate timely transitions of care, identify avoidable hospital days, and support documentation that justifies hospital stays. Qualifications require a diploma or associate degree in nursing (BSN preferred), a current RN license in SC or a compact state, and a minimum of 3 years of relevant experience. Knowledge of insurance, Medicare criteria, healthcare financial systems, and computer proficiency are essential. Key duties involve managing denied cases, coordinating with insurance for payment authorizations, and ensuring efficient patient flow. The role emphasizes interdisciplinary collaboration, process improvement, and education to optimize patient care and hospital resource use.