Rn Case Manager Jobs

About The Position

Requirements

• Graduate of an accredited nursing school.
• Current registered nurse licensure in the state of Nevada.
• Current CPR or BLS certification.
• At least three years of experience in clinical practice, an emergency room, or an intensive care unit, with good clinical skills.
• Familiarity with electronic health record systems.
• Valid driver’s license and/or dependable transportation.
• Ability to work independently under general instructions and collaboratively with a team.
• Computer literacy, including the ability to prepare complex reports and analyses.
• Detail-oriented, with the ability to handle multiple and shifting priorities.
• Ability to problem-solve, de-escalate and resolve conflict, and perform service recovery.
• Ability to use the AIDET tool set effectively.
• Demonstrated ability to produce consistently high-quality work and manage timelines and projects successfully.

Nice To Haves

• Bachelor’s degree in nursing.
• Prior clinical experience, preferably in an ambulatory, acute-care, skilled, or rehabilitation clinical setting.
• Previous experience in case management or utilization management.
• Knowledge of office laboratory procedures and pediatric and adult phlebotomy skills.
• Knowledge and skill in pediatric and adult medication and immunization administration.
• Knowledge of the essential functions, practices, and procedures of a medical clinic and office, including in-office procedures.
• Excellent people skills and customer-service acumen.
• Ability to interact effectively and positively with other staff members.

Responsibilities

• Manage members who are eligible for and require continuous, chronic, and/or high-intensity case management.
• Provide health education and coach patients on treatment alternatives to support informed decision-making.
• Support patients in selecting physicians and facilities to maximize access and quality while managing healthcare costs.
• Coordinate services and referrals to health programs.
• Take inbound calls and place outbound calls according to patient and business needs.
• Track and support patients who obtain services outside the practice.
• Analyze clinical protocols to identify potentially unnecessary services or care settings and recommend alternatives when appropriate.
• Use data reports and medical records to identify patients who are disconnected from the care system and proactively connect them with appropriate healthcare options.
• Follow up with patients within a few days of an emergency room visit or hospital discharge.
• Provide care management services for high-risk patients.
• Review clinical program information and use established screening criteria to identify members for case management or disease management activities and interventions.
• Identify the highest-risk clients with the greatest potential for improved health outcomes.
• Manage network participation, specialty-network care, DME-provider care, and transfers to alternative levels of care using knowledge of benefit plan design.
• Conduct patient encounters as needed.
• Complete special projects, initiatives, and other duties as assigned.