RN Case Manager PRN (As Needed)

Baptist Health • Prattville, AL

8d • Onsite

About The Position

The RN Case Manager works in either Utilization Management or Discharge Planning. In Discharge Planning, the Case Manager coordinates care for an assigned patient caseload in collaboration with physicians, nursing staff, and other health professionals to support efficient use of clinical resources, optimal clinical and continuing care, and financial outcomes. The role includes assessment, planning, facilitation, care coordination, evaluation, and advocacy to address patients’ and families’ comprehensive service needs through communication and available resources.

In Utilization Management, the RN collaborates with patients and families, the interdisciplinary team, and payers to assess care progression from the acute-care episode through post-discharge for quality, efficiency, and effectiveness. The RN coordinates care delivery across the continuum and completes admission, continued-stay, and discharge reviews in accordance with federal regulations, insurance guidelines, and Baptist Health’s Utilization Management Plan. The position also protects revenue by reconciling physician orders, bed billing type, and medical necessity. Additional duties may be assigned within the scope of the role.

Requirements

• Degree in Nursing.
• At least 2 years of hospital patient care experience.
• Active RN license.
• Basic computer skills.
• Strong oral, written, and interpersonal skills.
• Ability to work independently with minimal supervision.
• Ability to function in a high-stress environment with frequent interruptions and changing priorities.
• Knowledge of appropriate infection-control or isolation techniques when necessary.

Nice To Haves

• Bachelor’s degree preferred.
• Previous experience in home care, reimbursement, or hospital insurance preferred.
• Previous inpatient hospital case management experience, including utilization review, third-party payer reimbursement, DRGs, and home care.
• Case Manager certification preferred.

Responsibilities

• Coordinate care for an assigned patient caseload in collaboration with physicians, nursing staff, and other health professionals.
• Assess, plan, facilitate, coordinate, evaluate, and advocate for services addressing patients’ and families’ needs.
• Collaborate with patients and families, the interdisciplinary team, and payers to assess care progression from acute care through post-discharge.
• Coordinate care delivery across the continuum to ensure patient needs are met.
• Complete admission, continued-stay, and discharge reviews in accordance with federal regulations, insurance guidelines, and the Utilization Management Plan.
• Reconcile physician orders, bed billing type, and medical necessity to protect revenue.
• Travel to seminars when required.
• Work weekends and holidays and provide on-call coverage after hours, on weekends, and on holidays.

What This Job Offers

• Education Level: Associate degree