Nurse Case Manager

Job Description

Job Description

Position Summary

A healthcare organization is seeking a Registered Nurse (RN) Case Manager to support a coordinated, multidisciplinary approach to patient care across the care continuum. This role is responsible for assessing, planning, coordinating, and evaluating patient care needs while serving as a clinical resource for patients, families, physicians, and care teams.

The Nurse Case Manager plays a key role in facilitating safe, efficient, and effective care delivery by ensuring appropriate utilization of healthcare services and supporting optimal patient outcomes across inpatient and post-acute settings.

Education & Experience

• Graduation from an accredited school of nursing required
• Minimum of three (3) years of clinical nursing experience in an acute care hospital setting
• Minimum of three (3) years of experience in Case Management, Discharge Planning, or Utilization Review

Licensure & Certification

• Active Registered Nurse (RN) license in the state of practice (e.g., Nevada or equivalent)
• Current Basic Life Support (BLS) certification from the American Heart Association (AHA)

Additional & Preferred Qualifications

• Recent, documented experience in acute care hospital settings preferred
• Experience in one or more of the following areas strongly preferred:
  • Pediatric case management
  • Emergency Department (ED) clinical experience
  • Utilization Review or Discharge Planning
• Professional certification preferred, including:
  • Certified Case Manager (CCM)
  • Accredited Case Manager (ACM)
• Membership in professional organizations such as:
  • Commission for Case Manager Certification (CCMC)
  • American Case Management Association (ACMA)
• Strong understanding of healthcare reimbursement models and regulatory requirements

Knowledge

• Case management principles and nursing process standards
• Disease processes and standards of care across multiple specialties
• Patient care planning, assessment, and outcome evaluation techniques
• Nurse Practice Act, compliance standards, and regulatory requirements
• Third-party reimbursement systems and utilization management principles
• Hospital safety protocols, infection control, and patient rights
• Emergency response procedures and age-specific care considerations

Skills & Abilities

• Manage patients with varying acuity levels across the care continuum
• Analyze and interpret clinical documentation and medical records effectively
• Apply utilization management and reimbursement guidelines appropriately
• Use healthcare systems, electronic medical records, and case management tools proficiently
• Communicate clearly and effectively with diverse patient populations in high-stress environments
• Build and maintain collaborative working relationships with interdisciplinary healthcare teams
• Demonstrate strong organizational skills and attention to detail in clinical documentation and coordination
• Ensure safe, effective, and compliant use of clinical tools and healthcare systems