Registered Nurse Case Management

Ascension•Tulsa, OK

11d•Onsite

About The Position

Secures Patient-Centered Care: Ensures the right care at the right time by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions. Maximizes Financial Health: Protects and maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process. Drives Operational Efficiency: Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources. Upholds Quality and Compliance: Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.

Requirements

Registered Nurse obtained prior to hire date or job transfer date required.
Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
5+ years of RN experience
3+ years of Case Management experience

Nice To Haves

Certified Case Manager credentialed from the Commission for Case Manager Certification (CCMC) preferred. ACM also accepted.
Hospital discharge planning experience preferred

Responsibilities

Ensures the right care at the right time by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions.
Protects and maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process.
Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources.
Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.