Registered Nurse Case Manager (RN)

Conifer Health Solutions•Nacogdoches, TX

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 respecting their resources and right to self-determination. The role ensures care is provided at the appropriate level based on medical necessity and assesses transition needs to support timely throughput, safe discharge, and prevention of avoidable readmissions. The position integrates national case management standards across utilization management, transition management, care coordination, regulatory and accreditation compliance, and education for physicians, patients, families, and caregivers. It supports medical necessity and denial prevention, appropriate length of stay, readmission prevention, patient satisfaction, and efficient throughput while ensuring care is delivered in the appropriate sequence and at the appropriate level.

Requirements

Graduate of an accredited school of nursing.
At least 2 years of acute hospital patient care experience.
Current RN license for the state or states covered, as required by law, regulation, or policy.
Demonstrated organizational skills.
Excellent verbal and written communication skills.
Ability to lead and coordinate activities of a diverse group in a fast-paced environment.
Critical-thinking and problem-solving skills.
Computer literacy.

Nice To Haves

Academic degree in nursing (bachelor's or master's).
Acute hospital case management experience.
Accredited Case Manager (ACM) certification.

Responsibilities

Accurately screen for medical necessity and submit cases for Physician Advisor review.
Coordinate patient care.
Assess and reassess transition-planning needs.
Implement or oversee implementation of the transition plan.
Lead and facilitate multidisciplinary patient care conferences.
Manage concurrent disputes.
Make appropriate referrals to other departments.
Identify complex patients and refer them to Social Work Services.
Communicate the plan of care to patients and families.
Collaborate with physicians, office staff, and ancillary departments.
Lead and facilitate Complex Case Review.
Ensure patient education is completed to support post-acute needs.
Complete timely, accurate, and concise documentation in the Tenet Case Management documentation 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.