RN Case Manager Utilization Review

Job Summary:

The Registered Nurse Case Manager with Utilization Review experience is responsible for collaborating with physicians and multidisciplinary teams to develop and implement patient care plans. This role involves monitoring patient progress, identifying and resolving barriers to care, managing discharge planning, and maintaining an active caseload. The RN Case Manager promotes integration of services including behavioral health and community support, ensuring compliance with education and regulatory requirements. Strong judgment, communication, and organizational skills are essential in a fast-paced healthcare environment. Responsibilities:

• Collaborate with physicians and multidisciplinary teams to develop and implement patient care plans.
• Monitor patient progress towards desired outcomes through assessments and review of patient records.
• Identify and resolve barriers to effective patient care and actively participate in discharge planning.
• Complete comprehensive assessments and determine case management eligibility based on clinical judgment and assessment triggers.
• Develop, implement, and monitor case management plans in collaboration with patients, caregivers, and healthcare professionals.
• Maintain an ongoing caseload for regular outreach and management.
• Promote integration and continuity of services, including behavioral health and community support.
• Ensure timely completion of all required education and compliance with regulatory and policy requirements.
• Utilize strong judgment, communication, and organizational skills in a busy and sometimes stressful healthcare environment.

Required Skills & Certifications:

• Active Registered Nurse license in Montana.
• AHA Basic Life Support (BLS) certification.
• Minimum of 2 years nursing experience.
• Experience in utilization review.
• Strong clinical assessment and case management skills.
• Excellent communication and organizational abilities.

Preferred Skills & Certifications:

• Bachelor of Science in Nursing (BSN) degree.
• At least 2 years acute care hospital case management experience.

Special Considerations:

• Flexibility to work extended hours, weekends, on-call, and after-hours as needed.
• Physical requirements include lifting, standing, walking, and fine finger movements.
• Exposure to healthcare-related hazards and emotionally challenging situations.

Scheduling:

• Work schedule includes variable shifts with potential extended hours, weekend coverage, and on-call responsibilities.