RN Case Manager-Weekends

IU Health•Carmel, IN

19h•Onsite

About The Position

The Registered Nurse Case Manager serves as an integral member of the interdisciplinary care team, coordinating and facilitating patient care across the continuum from pre-admission through post-discharge. This role is responsible for ensuring patients receive the appropriate level of care, timely access to services, and safe, effective transitions to the next level of care. The RN Case Manager collaborates closely with physicians, nursing staff, social workers, and community resources to promote optimal patient outcomes, effective resource utilization, and regulatory compliance. The ideal candidate is a clinically experienced nurse with strong critical thinking skills and a passion for patient advocacy and care coordination. Previous inpatient hospital case management experience is strongly preferred.

Requirements

Associate's Degree in Nursing required.
Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
Requires knowledge of various software applications including Windows; Cerner; CarePort; and SMS.
3-5 years of experience required.
Requires strong clinical background in acute care.

Nice To Haves

BSN preferred.
Certification in Case Management preferred.
Knowledge of Medicare/Medicaid, insurance and regulatory guidelines is preferred.
Ability to comprehend third party contractual arrangements is preferred.
Understanding of the third party denial and appeal process is preferred.

Responsibilities

Coordinate and manage patient care throughout the hospitalization and discharge process.
Conduct comprehensive assessments to determine appropriate level of care and resource needs.
Facilitate timely and effective discharge planning to ensure safe transitions across the continuum of care.
Collaborate with multidisciplinary teams to develop and implement patient-centered care plans.
Monitor patient progression and identify barriers to discharge, proactively coordinating solutions.
Partner with insurance providers and third-party payers to obtain authorizations, ensure coverage, and promote appropriate utilization of healthcare services.
Review clinical documentation and patient status utilizing established criteria and regulatory guidelines.
Participate in denial prevention efforts and assist with appeals when necessary.
Provide patient and family education related to care transitions, available resources, and prevention initiatives.
Maintain compliance with federal, state, payer, and organizational requirements related to case management and utilization review.