RN Case Manager - Case Management

Health First Careers•Brevard County, FL

About The Position

The RN Case Manager provides quality, safe, customer-focused care and stewardship through advanced clinical assessment, planning, intervention, and evaluation. The role follows Federal Conditions of Participation, Florida regulations, and Joint Commission accreditation standards. Working with the interdisciplinary team, patients, families, and support personnel, the RN Case Manager promotes optimal outcomes through effective resource utilization and discharge planning for hospital admissions. The position initiates care transitions at admission and develops or revises individualized discharge plans based on patient assessment and response to treatment. It identifies at-risk patients, supports safe transitions to the next level of care, addresses barriers to discharge, and helps ensure appropriate, cost-effective care. The RN Case Manager also supports compliance with specified Medicare and reporting requirements, coordinates authorizations and referrals, evaluates daily care plans, and upholds patient rights. The schedule is four 10-hour shifts, 9:30 a.m. to 8:00 p.m., including one weekend per month. The posting separately lists shift times as 10:00 a.m. to 8:00 p.m. This is a full-time position.

Requirements

Associate Degree in Nursing.
Current, valid State of Florida RN license or endorsement.
Current American Heart Association Basic Life Support Healthcare Provider Completion Card upon hire and maintained.
At least three years of clinical experience in an acute care hospital.
Strong analytical, data management, and computer skills.
Excellent interpersonal communication and negotiation skills.
Demonstrated critical thinking in resolving or escalating barriers.
Ability to work autonomously and prioritize multiple tasks and role components.
Ability to exercise sound judgment in interactions with physicians, payers, patients, and families.
Flexibility to meet needs in high-demand and stressful situations.

Nice To Haves

BSN or bachelor’s degree in a related field.
CCM or ACM certification.
Case management experience in an acute care hospital.
Knowledge of care transitions, utilization management, case management, performance improvement, and managed care reimbursement.
Comprehensive knowledge of continuum-of-care post-acute community resources.

Responsibilities

Initiate care transitions at admission and develop or revise individualized discharge plans based on assessment, reassessment, and response to treatment.
Identify at-risk populations using approved screening tools and follow referral processes to support safe transitions and prevent readmissions.
Practice autonomously in accordance with evidence-based standards.
Serve as a case management resource for compliance with Medicare IM letters, 3008, 1823 PASSR, and DCF mandatory legal reporting requirements.
Work with the Utilization Department, Physician Advisors, Hospitalists, Emergency and other physicians to promote appropriate, cost-effective care and optimal patient outcomes.
Identify, resolve, or escalate delays and obstacles to discharge.
Identify reimbursement factors affecting post-hospital provider choices and obtain authorizations directly or in collaboration with payer case managers.
Evaluate the effectiveness of patients’ daily plans and involve patients and families in developing plan goals.
Communicate and collaborate with physicians, nursing, physician advisors, and interdisciplinary care team members to support timely resource management and patient transitions.
Support patient rights, informed consents, and advance directives.
Initiate referrals to the ethics committee, clinical social worker, risk management, or legal services as appropriate.