RN Case Manager
About The Position
The RN Case Manager coordinates care for ordering complex durable medical equipment and managing referrals for both un-resourced and resourced patients. This role involves assisting Purchase & Referred Care (PRC) staff, partnering with clinical care teams, and tracking/managing referrals. The RN Case Manager will collaborate with external case managers and social workers for hospitalized patients with complex needs, address case management consult requests, and provide input during PRC Committee meetings. Responsibilities include reviewing charts, care plans, contacting patients/families/providers, assessing care needs, reviewing patient eligibility, assisting patients in exploring alternate resources, scheduling appointments, revising care plans, collecting health records, and conducting follow-ups to ensure comprehensive patient treatment.
Requirements
- Degree or diploma from an accredited registered nursing program.
- Current, valid, unrestricted nursing license in a U.S. state, the District of Columbia, Puerto Rico, or a U.S. territory.
- At least 36 months of nursing experience, including 12 months in a related specialty.
- Current Basic Life Support (BLS) certification.
- Current Pediatric Advanced Life Support (PALS) certification.
Nice To Haves
- Advanced Cardiac Life Support (ACLS) certification.
- Neonatal Resuscitation Provider (NRP) certification.
- Trauma Nurse Critical Care (TNCC) certification.
- Nurse Specialty certification.
Responsibilities
- Coordinates care for ordering complex durable medical equipment and managing referrals for both un-resourced and resourced patients.
- Assists Purchase & Referred Care (PRC) staff in clarifying provider referrals/orders with non-Client vendors/providers.
- Partners with clinical care teams to ensure appropriate and timely referrals.
- Tracks and manages referrals entered by providers.
- Collaborates with external case managers and social workers for hospitalized patients with complex needs, including geriatric, pediatric, surgical, and trauma cases.
- Works with external vendors and partners to streamline referral processes.
- Addresses case management consult requests across all ambulatory clinics.
- Provides input during weekly PRC Committee meetings to support medical review members.
- Reviews charts, care plans, and contacts patients, families, and service providers to ensure care meets patient needs.
- Assesses care needs and resource utilization during consultations with healthcare providers.
- Reviews patient eligibility for care under applicable rules and regulations.
- Assists patients in exploring alternate resources, including Medicare, Medicaid, and private insurance options.
- Schedules medical appointments, therapies, and other services as needed.
- Revises care plans based on patient progress and input from healthcare providers.
- Collects and reviews health records to complete referrals and process payments.
- Ensures comprehensive and adequate patient treatment through appropriate documentation.
- Conducts follow-ups to confirm referral documentation and ensure patient treatment.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
