Registered Nurse (RN) - Case Manager

Conifer Health Solutions•El Paso, TX

About The Position

The RN Case Manager facilitates care along a continuum through effective resource coordination, helping patients achieve optimal health, access care, and use resources appropriately while respecting patient resources and the right to self-determination. The role ensures care is provided at the appropriate level based on medical necessity and assesses transition needs to promote timely throughput, safe discharge, and prevention of avoidable readmissions. The position integrates case management standards in utilization management, transition management, care coordination, regulatory and accreditation compliance, and education for physicians, patients, families, and caregivers. The role supports medical necessity and denial prevention, appropriate length of stay, readmission prevention, patient satisfaction, efficient care sequencing, and care 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(s) covered; must be licensed, certified, or registered to practice as required by law, regulation, or policy in the state of practice.
Ability to lift or position up to 25 lbs and push or pull up to 25 lbs of force.
Manual dexterity, mobility, touch, and auditory ability to perform the duties of the position.

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 needs and plans.
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 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.