Case Manager RN

Case Manager Registered Nurse (RN)

Cooperidge Consulting Firm is seeking a Case Manager Registered Nurse (RN) for a top Healthcare client.

The RN Case Manager (CM) serves as a Care Coordinator, facilitating the interdisciplinary plan of care with a focus on evaluating clinical appropriateness, medical necessity, level of care, and resource utilization. This role coordinates activities that promote quality outcomes and efficient patient throughput, identifies barriers to care, and assumes a leadership role in developing effective discharge plans.

Job Responsibilities

• Perform comprehensive assessments of the psychosocial and medical needs of assigned patients to develop a detailed case management plan of care.
• Evaluate admissions for medical necessity and appropriate observation status using approved criteria, escalating issues through the established chain of command as needed.
• Assume a leadership role with the interdisciplinary team to manage care, ensuring appropriate level of care, patient status, and resource utilization are maintained.
• Facilitate patient throughput with an ongoing focus on quality and efficiency, coordinating services necessary to meet identified post-discharge needs.
• Track and trend variances and barriers to care, making recommendations and developing action plans to improve processes and systems across the continuum.
• Perform utilization management reviews and communicate crucial information to third-party payors, acting as a liaison between all parties (physicians, hospital staff, outside agencies).
• Ensure compliance with all regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to the provision of Case Management Services.
• Document professional recommendations, care coordination interventions, and case management activities accurately to ensure effective communication across the healthcare team.