Rn Case Manager Jobs

About The Position

Requirements

• Graduate of an accredited nursing school.
• Current licensure as a registered nurse in the state of Nevada.
• Current CPR or BLS certification.
• At least three years of experience in clinical practice, ER, or ICU, 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 as part of a team.
• Excellent people skills and customer service acumen.
• Ability to interact effectively and positively with other staff members.
• Detail-oriented, with the ability to handle multiple and shifting priorities.
• Strong problem-solving, conflict de-escalation and resolution, and service-recovery abilities.
• Ability to effectively use the AIDET tool set.
• Demonstrated ability to produce high-quality work consistently and manage timelines and projects successfully.
• Computer literacy, including the ability to prepare complex reports and analyses.
• Ability to meet the physical demands of the position, including prolonged standing and walking, use of hands and arms, talking and hearing, stooping, kneeling or crouching, and regularly lifting and/or moving up to 20 pounds.

Nice To Haves

• Bachelor's degree in nursing.
• Prior clinical experience in an ambulatory, acute care, skilled nursing, 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.

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.
• Help patients select physicians and facilities to maximize access and quality while managing healthcare costs.
• Coordinate services and referrals to health programs, and make inbound and 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 disconnected from the healthcare system and proactively connect them with appropriate healthcare options.
• Follow up with patients within a few days of emergency room visits or hospital discharge and provide care management services to high-risk patients.
• Review clinical program information and apply established screening criteria to identify members for case management, disease management, or other interventions.
• Identify clients at highest risk who have 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.