Concurrent RN Care Manager
About The Position
The Concurrent RN Care Manager is responsible for concurrent utilization review, care coordination, and discharge planning for inpatient members within a managed care environment. This role serves as a clinical resource to care management staff, supports compliance with regulatory and health plan requirements, and collaborates with providers, hospitals, and interdisciplinary teams to ensure medically necessary, cost-effective, and quality care. The position performs medical necessity reviews using established criteria, monitors length of stay, facilitates transitions of care, and identifies opportunities to improve outcomes and reduce avoidable utilization.
Requirements
- Graduate of an accredited Registered Nursing program.
- Three (3) years of clinical nursing experience.
- 1-2 years in utilization management, case management, or managed care.
- Current State Registered Nursing License.
- Knowledge of utilization management standards (CMS, DMHC, InterQual/Milliman).
- Strong clinical assessment and critical thinking skills.
- Understanding of managed care and value-based care models.
- Excellent written and verbal communication skills.
- Ability to manage multiple cases and meet regulatory deadlines.
- Proficiency with electronic medical records (EMR) and Microsoft Office applications.
- Ability to work independently and collaboratively in a fast-paced environment.
- Strong organizational and time management skills.
- Sedentary work, including extended periods of sitting, computer use, and communication.
- Ability to review detailed medical documentation, perform data entry, and maintain sustained concentration and attention to detail.
- Ability to communicate effectively through verbal, written, and electronic means, including phone and video communication.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Experience in a health plan, MSO, IPA, or acute setting with utilization review responsibilities.
- Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.
Responsibilities
- Perform concurrent utilization reviews using established criteria.
- Conduct care coordination for inpatient members.
- Manage discharge planning for inpatient members.
- Serve as a clinical resource to care management staff.
- Support compliance with regulatory and health plan requirements.
- Collaborate with providers, hospitals, and interdisciplinary teams.
- Ensure medically necessary, cost-effective, and quality care.
- Monitor length of stay.
- Facilitate transitions of care.
- Identify opportunities to improve outcomes and reduce avoidable utilization.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
