CRC Case Manager RN

Job Description

Full-time| M-F, 8am-4:30pm| PG13| Weekly earned wage access is an option for this position.

Job Purpose or Objective(s): The Case Manager provides proactive case management for referred patients admitted to other facilities to ensure quality coordination of care. You will provide disease management to complex cases to ensure the best outcome. You will report to the Director.

Primary Tasks:

1. Request reviews on inpatient stays for approved dates of service; manage cases using CRC services and high-cost referrals to ensure criteria is met.
2. Ensure all available services within Choctaw Nation have been utilized before approving referrals.
3. Review transport reports from in-patient and ER to verify appropriate referrals have been completed.
4. Provide referral management based on the CRC medical priority guidelines.
5. Obtain prior authorization that requires in-depth medical knowledge.
6. Explain procedures and treatments to patients to gain cooperation, understanding, and allay apprehension.
7. Prepare and maintain written case records and reports.
8. Coordinate and schedule appointments for consultations, referrals, and tests.
9. Facilitate communication between care providers.
10. Perform other responsibilities as may be assigned.

Required Education and Experience:

• Associate degree in nursing
• Current RN licensure in state of Oklahoma. (or Multi-State Nursing License)
• Current Basic Life Support certification
• Two [2] years of experience

Skills:

• Action Planning
• Assessment
• Compliance Management
• Computer Skills
• Costing & Budgeting
• Customer Service Delivery
• Data Collection & Analysis
• Data Control
• Policy & Procedures
• Production Quality
• Review & Reporting
• Verbal Communication