Case Manager, RN Care Management Per Diem

About the role

The RN Case Manager is responsible for coordination of care, utilization review, acting as a resource to patient, family and nursing units; referrals to clinical social worker for psycho-social issues and complicated discharge planning issues; and overseeing coordination of post-hospital care needs; interacting with insurance companies, medical groups, and community resources to ensure timely, efficient use of all services.

Responsibilities

• Applies knowledge of the expected clinical process, available resources, medical necessity criteria, regulatory requirements, and relevant standards of care in anticipating patient needs.
• Responsible for case management across the continuum of care utilizing an interdisciplinary approach to managing patient throughput in a fiscally responsible manner to achieve optimal outcomes.
• Works as a member of a multidisciplinary team to actively facilitate those functions associated with the patient throughout an acute episode of care.

Qualifications

• Licensure and Certification: Current CA RN license, Current BLS provider card, Case Management certification preferred.
• Education: Diploma, AA, BS in Nursing, MS in Nursing preferred.
• Experience: Two (2) years as a Case Manager in an acute care setting or five years recent acute care nursing experience preferred.
• Demonstrates strong interpersonal skills, leadership ability, negotiation skills, and knowledge of hospital operations.
• General knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential.
• Knowledge of InterQual and/or Milliman preferred.