Registered Nurse Case Manager (RN)

Conifer Health Solutions•Joshua Tree, CA

About The Position

The RN Case Manager facilitates care across the continuum through effective resource coordination, helping patients achieve optimal health, access care, and use resources appropriately while balancing available resources with each patient’s right to self-determination. The role is responsible for ensuring care is delivered at the appropriate level based on medical necessity and assessing transition needs to support timely throughput, safe discharge, and prevention of avoidable readmissions. The position is full-time, day shift, with hours of 0800–1630 and 10 shifts per two-pay-period schedule. Rotating weekends are required. A sign-on bonus of up to $25,000 is available based on experience.

Requirements

California Registered Nurse license.
At least two years of acute hospital patient care experience.
Demonstrated organizational skills.
Excellent verbal and written communication skills.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Accredited Case Manager (ACM) certification.
Acute hospital case management experience.

Responsibilities

Support utilization management, including medical necessity and denial prevention.
Manage transitions to promote appropriate length of stay, prevent readmissions, and support patient satisfaction.
Coordinate care and demonstrate throughput efficiency while ensuring care is delivered in the appropriate sequence and at the appropriate level.
Comply with state and federal regulations, TJC accreditation standards, and Tenet policy.
Provide education to physicians, patients, families, and caregivers.
Complete accurate medical necessity screening and submit cases for Physician Advisor review.
Maintain timely, complete, and concise documentation in the Case Management system.
Maintain accurate patient demographic and insurance information.
Identify and document potentially avoidable days.
Identify and report overutilization and underutilization.
Perform other duties as assigned.