Case Manager - RN

About the role

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.

Responsibilities

• Perform chart reviews for admission, concurrent, and retrospective cases to ensure documentation accuracy, appropriate stay, and reduce denial risks.
• Collaborate with payers and healthcare teams to manage patient progression, discharge planning, and resource utilization.
• Work closely with social workers and discharge planners to facilitate timely transitions of care.
• Identify avoidable hospital days and support documentation that justifies hospital stays.
• Manage denied cases and coordinate with insurance for payment authorizations.
• Ensure efficient patient flow through interdisciplinary collaboration, process improvement, and education to optimize patient care and hospital resource use.

Qualifications

• Diploma or associate degree in nursing (BSN preferred).
• Current RN license in SC or a compact state.
• Minimum of 3 years of relevant experience.
• Knowledge of insurance, Medicare criteria, and healthcare financial systems.
• Computer proficiency.