RN Care Mgr UR Case Mgmt
About The Position
The RN Care Manager conducts comprehensive assessments and develops plans to implement, coordinate, monitor, and evaluate cost-effective healthcare services tailored to each individual’s needs. The role performs utilization reviews to assess the appropriateness and medical necessity of services and fosters relationships with payers to support compliance and alignment. The RN Care Manager advocates for patients navigating the healthcare system, helping ensure their preferences and rights are respected and that they can access appropriate care or coverage. The position coordinates care with patients, families, healthcare staff, physicians, Advanced Practice Providers, and community services. It incorporates cultural competence and Social Determinants of Health into assessments and care plans, leads discharge planning and care coordination to help minimize readmissions, monitors performance indicators such as length of stay and readmission rates, and ensures adherence to CMS, Joint Commission, and payer requirements. Reports to the Director of Research and Innovation, in collaboration with the CNO/VP of Patient Care Services.
Requirements
- Registered nurse with a current North Carolina license.
- Current BLS Healthcare Provider certification.
- Three years of clinical experience in a healthcare facility.
- Knowledge of clinical nursing principles.
- Knowledge of current trends and issues related to utilization and case management principles in the hospital practice setting.
- Computer experience.
- Evidence of participation in ongoing continuing education programs.
Nice To Haves
- BSN preferred.
- Case Management Certification (CCM), Accredited Case Manager (ACM), and/or Health Care Quality and Management (HCQM) certification preferred.
Responsibilities
- Conduct comprehensive patient assessments and develop plans to implement, coordinate, monitor, and evaluate healthcare services.
- Perform utilization reviews to assess the appropriateness and medical necessity of healthcare services.
- Build relationships with payers to support compliance and alignment.
- Advocate for patients, respect their preferences and rights, and help them access appropriate care or coverage.
- Coordinate care with patients, families, healthcare staff, physicians, Advanced Practice Providers, and community services.
- Incorporate cultural competence and Social Determinants of Health into assessments and care plans.
- Lead discharge planning and care coordination initiatives aimed at minimizing readmissions.
- Collaborate with interdisciplinary teams to create and refine patient-centered care plans.
- Monitor performance indicators, including length of stay and readmission rates.
- Adhere to CMS, Joint Commission, and relevant payer requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
