RN Case Manager

Job Summary

The RN Case Manager plays a critical role in optimizing patient care and resource utilization. The incumbent is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs. This role focuses on quality patient outcomes and cost-effective healthcare delivery and may encompass general medical case management or specialize in high-acuity areas and/or high-cost areas such as high-risk obstetrics and neonatal care, chronic disease management, and/or mental health support (excludes Behavioral Health).

Requirements

• Educational Requirement: Bachelor's degree in Nursing preferred.
• Licensing/Certification: Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required. Case management certification required. If certification is not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager. The acceptable case management certifications are Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse - Board Certified (RN-BC).
• Experience: Minimum four (4) years' clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.

Essential Abilities & Skills

• Independence
• Detail oriented
• Skills: Administrative Process Affinite CM Affinite UM CCI Edits Collaborative Communications Critical Reasoning Cross-Functional Planning Customer Relationship Management (CRM) Customer Service Workstation Deductive Reasoning Five9 Information Security Interpersonal Relationship Management Microsoft Excel Microsoft Office Microsoft Outlook Microsoft PowerPoint Needs Assessment Oral Communications Problem Sensitivity Researching Sound Judgment Support Coordination Written Communication

Responsibilities

• Assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet an individual’s health needs through the use of plan benefits and community resources to facilitate appropriate cost effectiveness and cost containment measures are met.
• Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations and makes decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Provides specialized education and knowledge on disease specific conditions as needed and assigned.
• Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, enterprise procedures, policies and contracts.
• Serves as a liaison facilitating a collaborative process which includes patients, families/caregivers, physicians, hospital discharger planners, home care providers and other ancillary providers to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.
• Works proactively with referrals from multiple sources to identify appropriate candidates for case management, explains services ensuring voluntary agreement of services and maintains a minimum patient caseload in a timely matter.

Certifications

• Accredited Case Manager (ACM) - American Case Management Association (ACMA)
• Certified Case Manager (CCM) - The Commission for Case Manager Certification (CCMC)
• Registered Nurse (RN) - Arkansas State Board of Nursing

Security Requirements

• This position is identified as level three (3).
• This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained.
• The integrity of information must be maintained as outlined in the company Administrative Manual.
• Segregation of Duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business.