Registered Nurse (RN) - Case Management

Case Manager – Medical Review

Schedule: 5 x 8-hour days

Requirements:

• State or Compact license must be in hand at time of submittal
• BLS certification required
• 2 years of experience preferred
• Prior charge experience preferred
• Experience with Epic charting system required
• Knowledge of medical necessity determination and utilization review
• Familiarity with discharge planning and care coordination
• Understanding of HIPAA and benefits eligibility/processes
• Knowledge of community resources and DME ordering needs

Roles & Responsibilities:

• Assess and communicate necessary changes to care plans.
• Refer patients to appropriate community resources.
• Manage length-of-stay (LOS) effectively.
• Facilitate timely transition planning and ensure timely/documented screenings and discharge plans.
• Conduct concurrent/continued stay reviews, and manage appeals and denials.

Compliance / Notes:

• Orientation/modules completed onsite.
• Core items/labs must be completed within 48 hours of contract signing.
• Requested time off must be listed at time of submittal.
• All compliance items must be adhered to at the time of onboarding.