RN - Case Manager

Job Opportunity

Position: Case Manager

Job Description

We are seeking a qualified Case Manager to join our team. The ideal candidate will coordinate patient care and ensure optimal treatment pathways, while floating between units as necessary. This role requires strong management skills along with a dedicated approach to patient care.

Key Responsibilities

• Manage a caseload of approximately 20 patients.
• Coordinate care for patients, focusing on discharge planning and medical necessity.
• Conduct needs assessments and order durable medical equipment (DME).
• Assist in appeals and denials processes related to care and treatment.
• Ensure compliance with HIPAA and CMS guidelines.
• Collaborate with interdisciplinary teams, including social services and medical professionals.
• Provide education regarding admission criteria and prior authorizations.

Schedule

This position requires: - Weekend coverage every other weekend - Block scheduling - On-call duties are not required

Qualifications

• Minimum of 2 years of case management experience in an acute care hospital setting.
• Experience with charting systems, preferably Epic.
• Certifications required: BLS and Case Management Certification.
• Ability to assess patients for behavioral health needs is advantageous.

Skills Required

• Knowledge of acute hospital care processes and discharge planning.
• Familiarity with HEDIS measures and DRGs.
• Proficient in navigating insurance company requirements.
• Strong communication and organizational skills.

Additional Information

Must commit to working 3 of the 5 major holidays: Thanksgiving, Christmas Eve, Christmas Day, New Year's Eve, and New Year's Day.

Pre-approved time off is limited, and all scheduling requests must be made upfront during the application process.

Patient Care Details

• Patient Age Groups: Adults
• Daily Census: 320 patients
• Expected to float between sister facilities if required for the assignment.

Application Process

Interested candidates are encouraged to apply and provide references covering the last year of work experience during the compliance process before starting.