RN Case Manager

Job Summary:

The RN Case Manager is responsible for the development, implementation, and evaluation of the Case Management Plan within a hospital setting. This role involves assessing, planning, coordinating, monitoring, and evaluating patient care services to meet health and human service needs. The RN Case Manager collaborates with interdisciplinary teams, advocates for patients, manages resources effectively, and ensures compliance with federal and state regulations. A minimum of three years clinical hospital experience and five years case management experience are required, along with a Bachelor's degree in nursing. Responsibilities:

• Develop, implement, and improve the case management system through ongoing interaction with patients, physicians, and healthcare providers.
• Document case management plans clearly and concisely.
• Assist physicians, patients, families, staff, and payers in delivering appropriate, effective, and cost-efficient care.
• Participate actively in departmental and interdepartmental meetings related to case management and social services.
• Collaborate with payers and review organizations to ensure proper utilization of patient care resources.
• Educate physicians and staff on appropriate levels of care and utilization issues.
• Maintain current knowledge of case management, discharge planning, and nursing issues through continuing education.
• Suggest and introduce new methods and techniques to improve case management processes.
• Participate in professional activities to support ongoing professional development.
• Ensure compliance with federal and state regulations related to billing and utilization review.

Required Skills & Certifications:

• Bachelor's Degree in Nursing (Master's degree preferred).
• At least three years clinical experience in a hospital setting.
• At least five years case management experience in a hospital setting.
• Current unrestricted Registered Nurse license in the State of Colorado.
• Current Basic Life Support (BLS) certification.

Preferred Skills & Certifications:

• Certification in case management or willingness to obtain within two years of employment.

Special Considerations:

• Weekend coverage required: 5 hours for one Saturday each month, with compensatory time off during the week.
• Work involves collaboration with multiple stakeholders including patients, physicians, payers, and interdisciplinary teams.
• Must maintain knowledge of regulations and compliance related to billing and utilization review.

Scheduling:

• Full-time position with weekend coverage as specified.
• Schedule includes one Saturday per month for 5 hours, with 5 hours off on another weekday.