Registered Nurse (RN) - Case Manager

Conifer Health Solutions • Rock Hill, SC

1d

About The Position

The Case Manager is responsible for coordinating patient care activities to conform to evidence-based practice and/or regulatory/payor requirements. The individual’s responsibilities will include, but not be limited to the following activities: a) medical necessity screening b) care coordination c) discharge planning d) facilitating multi-disciplinary patient care conferences e) managing concurrent disputes f) making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST) g) referring complex social issues to Social Service h ) communicating with patients and their families about plan of care i) collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy) j) participating in weekly Complex Case Review k) arranging for post –discharge patient education l) clear, complete and concise documentation in eCCM m) maintaining accuracy of patient demographic and insurance information n) identifying and documenting potentially avoidable days o) identifying and reporting over and under utilization.

Requirements

• Education: Associates in Nursing required.
• Experience: at least 3 to 5 years' experience in the relevant clinical specialty (e.g., case manager for pediatrics patients should have pediatric nursing experience)
• Licensure/Certification: Valid Permanent Multi-State RN License from the state in which you reside is required
• Hold a RN license from another Compact state, you are required to apply for and obtain a Multi-State RN License from the state in which you reside within 30 days
• American Heart Association BLS CPR Required, must be obtained within 7 days of hire

Nice To Haves

• Education: BSN preferred

Responsibilities

• Implements the Utilization Management process, according to the Piedmont Utilization Review Plan.
• Coordinate clinical care in conjunction with all members of the healthcare team, including physicians, nurses, other clinical staff, and the patients/ families.
• Assesses post-acute care needs and collaborates with healthcare team to facilitate patient’s transition from acute care setting.
• Meets communication standards for the department.
• Performs related duties as required.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees