RN Case Manager - PRN - Mon. - Fri. Availability (8am to 4:30pm)

About the role

This role handles multi-disciplinary communications and facilitation of care throughout a patient’s hospitalization. Responsibilities include reviewing appropriate utilization of resources, ensuring medically necessary hospital care criteria are met, and confirming clear, specific level-of-care orders and documentation in the medical record. The position serves as a liaison between patients, caregivers, multi-disciplinary team members, post-acute providers, and third-party payers. Collaborates with the care team to develop and implement discharge plans tailored to the patient’s individualized needs.

Responsibilities

• Performs pre-admission, admission, and continued stay reviews as directed per CMS guidelines, commercial payer guidelines, and/or hospital policy.
• Supports the values of service excellence, teamwork, and integrity while maintaining minimum standards for licensure and pursuing personal/professional development.
• Maintains knowledge of conditions of participation related to utilization review and discharge planning.
• Maintains open communication with all appropriate parties, functioning as a liaison between ED physicians, hospitalists, attending physicians, and physician advisors.
• Leads oversight and management of functional and financial outcomes, including coordination and implementation of the discharge plan during acute-care hospitalization.
• Adapts behavior to the specific patient population, including respect for privacy, method of introduction, explanation of services, requesting permissions, and communication style.
• Remains knowledgeable on current federal, state, and local laws, accreditation standards, or regulatory agency requirements applicable to the assigned area and ensures compliance.
• Performs other related duties as required.

Requirements

• Current registered nurse license in the state of practice.
• Basic Life Support (BLS) certification from the American Heart Association.
• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills, with the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Strong interpersonal skills.
• Ability to work a flexible schedule (e.g., 24/7, weekends, holidays, on-call availability).

Qualifications

• Education Required: Registered nurse diploma or equivalent.
• Work Experience Preferred: Bachelor’s degree in nursing.
• Work Experience Required: None.
• Work Experience Preferred: 3 years of hospital-based experience in discharge planning, case management, or utilization review.
• Certifications Preferred: Certification in Case Management (CCM) or Accredited Case Manager (ACM).

Physical and Environmental Demands

The physical demands described are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Medium Work: Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.
• Duties performed routinely require exposure to blood, body fluid, and tissue.
• Works in a patient care area, directly with patients, and/or with specimens that could contain diseases, posing an occupational risk for exposure to communicable diseases.
• Potential occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning, and/or disposal of contaminated waste.