Case Management Nurse

Job Description: Registered Nurse (RN) - Case Management We are seeking a qualified Registered Nurse (RN) with a minimum of two years of experience in case/resource management and utilization management. This non-clinical role focuses on supporting patients through the healthcare continuum, ensuring appropriate utilization of resources, and promoting optimal care outcomes. Key Responsibilities: Perform case and resource management to ensure efficient and appropriate care coordination. Conduct utilization reviews to assess the necessity and appropriateness of medical services. Collaborate with healthcare teams to coordinate care and manage patient transitions. Utilize electronic medical records systems such as EPIC for documentation and reporting. Apply knowledge of PRI (Patient Review Instrument) and SCREEN processes as applicable. Required Qualifications: Active New York State RN License. Minimum two (2) years of experience in case/resource management and utilization management. AHA Basic Life Support (BLS) certification. Primary Source Verification of credentials. Preferred Qualifications: Three to five (3–5) years of experience in care management. Experience with EPIC electronic health records. Certification or experience in PRI and SCREEN assessments. Note: The description contains extraneous information about other jobs and company benefits, which should be omitted for clarity and focus on the role. #J-18808-Ljbffr Pride Health