RN-Acute Care Case Manager

About the Role

Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery, and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during hospitalization, illness, and/or life situation. Performs other duties as assigned.

Responsibilities

• Utilization Review
• Discharge planning
• Readmission Reduction Participation
• Payer Communication and denial reduction
• Completes assigned goals

Requirements

• RN with at least one (1) year of clinical experience
• Diploma or Associate Degree in Nursing (minimum required)
• RN licensure (minimum required)

Qualifications

• RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting (preferred)
• BSN or MSN (preferred)
• Certified Case Manager (preferred)
• CCM or ACM certification (preferred)

Skills

• Critical thinking skills
• Communication skills
• Organization skills
• Interpersonal skills
• Computer skills
• Problem solving
• Knowledge of governmental regulations
• Knowledge of payer requirements (preferred)