Nurse Case Manager

About the role

Provides case management services to a caseload of low- and medium-risk patients. Interviews patients and their caregivers to evaluate needs, goals, and current services. Determines initial eligibility, benefits, and education for all admissions, assessing medical necessity and required level of care to inform physicians. Reviews and enters authorization data. Develops a client-focused case management plan in collaboration with the healthcare team, patient, and caregivers that is consistent with regulatory, accreditation, and regional guidelines. Assists patients with gaining access to care based on their needs, making referrals as appropriate. Coordinates resources and services to assure continuity and quality of care. Attends case management rounds with clinicians and reviews authorizations and diagnoses as needed. Assesses patient progress toward treatment milestones and care plan goals. Identifies barriers to achieving goals and ensures that they are discussed with the patient and care team thoroughly. Verifies that all services remain consistent with established guidelines and standards. Documents the patient’s case in all medical files. Reviews benefits/services available to patients, caregivers, and other members of the community and assists with problem solving identified concerns. Identifies patients ready for disposition planning activities. Develops and communicates a comprehensive disposition plan in collaboration with the patient, caregivers, physician, nurses, social services, and other healthcare providers and agencies. Obtains authorizations as needed for patient services. Attends professional seminars, workshops, and approved educational programs. Monitors operational team data and key metrics applied to own work. Makes suggestions for change or improvement as needed. Ensures adherence to policies to meet regulatory requirements.

Responsibilities

• Interviews patients and families to evaluate needs, goals, and current services with minimal day-to-day supervision.
• Determines initial eligibility, benefits, and education for all admissions independently.
• Reviews and enters authorization data (e.g., admitting/principal diagnoses, bed types, disposition data) and identifies/document inaccuracies.
• Assesses medical necessity for hospital admission and required level of care to inform physicians.
• Coordinates resources and services to assure continuity and quality of care.
• Attends case management rounds with clinicians and reviews diagnoses as needed.
• Contacts patients periodically to assess progress toward treatment milestones and care plan goals independently.
• Identifies barriers to achieving goals and ensures they are discussed with the patient and care team thoroughly.
• Verifies that all services remain consistent with established guidelines and standards independently.
• Documents/updates the patient’s case in all medical files independently.
• Creates a client-focused case management plan with treatment goals based on patient and family/caregiver needs under limited direction.
• Collaborates with the healthcare team, patient, and caregivers to ensure the plan of care is safe, agreeable, and appropriate with minimal guidance.
• Validates that the plan is consistent with regulatory, accreditation, and regional guidelines independently.
• Identifies patients ready for disposition planning activities under limited guidance.
• Develops, evaluates, coordinates, and communicates a comprehensive disposition plan in collaboration with the patient, family, physician, nurses, social services, and other healthcare providers and agencies to meet each patient’s personal, psychosocial, economic, and cultural needs with guidance.
• Obtains authorizations/approvals as needed for services for the patient with minimal supervision.
• Assists patients with gaining access to care based on their needs and integrates or refers them into existing programs/services independently.
• Refers patients to outside entities, ambulatory case managers, care managers, social workers, and/or internal/external resources as appropriate with minimal guidance.
• Reviews benefits/services available based on regulations or specific coverage to patients, families, and other members of the community and assists with problem solving identified concerns under limited supervision.
• Acts as a resource for physicians, health plan administrators, and contracted vendors leveraging comprehensive knowledge of the patient’s case.

Minimum Qualifications

• Bachelor’s degree in Nursing or related field.
• Minimum three (3) years of experience in nursing, case management, or a directly related field.
• Registered Professional Nurse License (Georgia) required at hire.

Preferred Qualifications

• Certified Case Manager (CCM) in the state where care is provided.
• Basic Life Support (BLS) Certification.

Skills

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication
• Acts with Compassion
• Business Relationship Management
• Community Health
• Company Representation
• Confidentiality
• Health Care Compliance
• Maintain Files and Records
• Managing Diverse Relationships
• Member Service
• Patient Safety
• Quality Assurance and Effectiveness
• Relationship Building
• Written Communication

Pay

$47.4 – $61.29 per hour

Schedule

• Part-time
• Sunday, Wednesday, Thursday, Friday, Saturday
• 08:30 AM – 05:00 PM
• Onsite in Atlanta, Georgia
• Travel: up to 5% of the time