RN Case Manager

Job Summary

The RN Case Manager provides individual patient care coordination and discharge planning throughout the continuum of care. This role encompasses utilization management, transfer coordination, and clinical documentation improvement to ensure optimal clinical outcomes and customer service. The RN Case Manager works closely with patients, their families, physicians, and healthcare team members to facilitate and expedite care delivery during the entire episode of care.

Key Responsibilities

• Conducts assessments of assigned patients to identify psychosocial support needs, living situations, financial status, and barriers to effective transition to lower levels of care.
• Performs utilization reviews to evaluate the necessity for observation, short surgical stay, or inpatient admissions using established criteria.
• Collaborates with multidisciplinary teams to develop and implement comprehensive discharge plans based on patient and family needs.
• Serves as a resource for physicians regarding discharge planning, medical record documentation, and resource utilization issues.
• Monitors and evaluates quality and customer service in patient care, initiating appropriate follow-up in response to identified issues.
• Conducts clinical documentation audits and provides education to healthcare professionals on improving documentation practices.
• Maintains knowledge of Medicare, Medicaid, and managed care requirements and collaborates with community agencies to ensure the best care delivery.

Qualifications

• Completion of an accredited nursing program; Bachelor’s degree preferred.
• Minimum of 3 years of experience in an acute hospital setting or a Master’s degree in Case Management.
• Strong computer skills with database management experience preferred.
• Effective communication skills; bilingual abilities are preferred.
• Experience in utilization review and discharge planning preferred.
• Certification as a Certified Case Manager (CCM) is preferred.
• Current CPR/BLS certification required.

Knowledge, Skills, and Abilities

• Critical thinking and strong organizational skills.
• Clinical knowledge and nursing skills.
• Familiarity with care coordination and discharge planning processes.
• Understanding of InterQual criteria and insurance regulations.

Physical Demands

This position requires the ability to walk, stand, sit, talk, and hear. The employee may occasionally lift and/or move up to 50 pounds and might be exposed to infections, hazardous materials, and a variety of working conditions typical of a hospital environment.

Service Standards

Maintain a safe environment, respect patients and colleagues, ensure effective communication, uphold a professional image, and work efficiently to exceed service expectations.