About The Position
The RN Case Manager supports physicians and the interdisciplinary team in providing patient care, with the goals of improving clinical outcomes and patient satisfaction, managing the cost of care, and providing timely, accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning. The Case Manager is accountable for a designated patient caseload and plans care to meet patient needs, manage length of stay, and promote efficient resource use. Responsibilities include facilitating pre-certification and payer authorization, coordinating collaborative patient care across the continuum, and addressing barriers to timely and efficient care delivery and reimbursement. The Case Manager applies process improvement methodologies to evaluate outcomes, supports and coaches clinical documentation, serves as a clinical resource for coders, ensures documentation reflects severity of illness and intensity of service, and coordinates communication with physicians.
Requirements
- Associate’s Degree in Nursing.
- Registered Nurse (RN) certification from the California Board of Registered Nursing.
- Basic Life Support (BLS) Healthcare Provider certification from the American Heart Association.
- Workplace Violence Training Program.
- Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and their families.
- Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
- Excellent interpersonal communication and negotiation skills.
- Strong organizational and time management skills, including the ability to prioritize multiple tasks and role components.
- Understanding of pre-acute and post-acute care settings and post-acute community resources.
- Strong analytical, data management, and PC skills.
Nice To Haves
- Bachelor’s Degree in Nursing.
- Three years of clinical experience in utilization review and discharge planning in an acute hospital is strongly preferred.
Responsibilities
- Support physicians and the interdisciplinary team in providing patient care.
- Coordinate utilization management, care facilitation, and discharge planning.
- Manage a designated patient caseload to meet patient needs, manage length of stay, and promote efficient resource use.
- Facilitate pre-certification and payer authorization processes.
- Facilitate collaborative management of patient care across the continuum.
- Intervene to remove barriers to timely and efficient care delivery and reimbursement.
- Apply process improvement methodologies to evaluate outcomes of care.
- Support and coach clinical documentation efforts and serve as a clinical resource for coders.
- Ensure documentation accurately reflects severity of illness and intensity of service.
- Coordinate communication with physicians.
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What This Job Offers
Job Type
Part-time
Education Level
Associate degree
