RN Case Manager - Per Diem
About The Position
The RN Case Manager functions as the leader of the interdisciplinary team. The role interacts by phone and face to face with physicians, nurses, discharge planners, insurance providers, and others to help ensure patients receive appropriate and necessary treatment under the correct admission status. The RN Case Manager assesses, plans, coordinates, and evaluates patient needs and services; completes utilization review activities to ensure compliance with state, federal, and other payor requirements; and participates in performance improvement initiatives related to patient care management as appropriate. Other duties may be assigned. The position calls for strong interpersonal and teamwork skills, sound judgment, adaptability, integrity, effective communication, and respect for diversity and inclusion. Annual threshold requirements include Joint Commission-mandated education, in-service and health requirements, attendance at new employee orientation, TB/PPD surveillance maintenance, and continued maintenance of required professional licenses and certifications.
Requirements
- Graduate of an accredited school of professional nursing.
- Current RN licensure in the state of Florida.
- BLS Certification from the American Heart Association for Healthcare Providers.
- Three years of acute health care nursing experience.
- Excellent interpersonal skills with patients, case management staff, physicians, insurance providers, transportation services, and peers.
- Critical thinking skills and decisive judgment.
- Ability to work with deadlines and multiple tasks.
- Knowledge of InterQual or Milliman admission criteria.
- Knowledge of federal and state regulations.
Nice To Haves
- Bachelor of Science in Nursing (BSN) preferred.
Responsibilities
- Lead the interdisciplinary team.
- Interact with physicians, nurses, discharge planners, insurance providers, and others by phone and face to face to help ensure patients receive appropriate and necessary treatment under the correct admission status.
- Assess, plan, coordinate, and evaluate patient needs and services.
- Coordinate and complete utilization review activities to ensure compliance with state, federal, and other payor requirements.
- Participate in performance improvement initiatives related to the management of patient care, as appropriate.
- Perform other duties as assigned.
- Complete annual Joint Commission-mandated education, in-service and health requirements, and new employee orientation attendance requirements.
- Maintain participation in the TB/PPD Surveillance Program and maintain required professional licenses and certifications.
