Job Summary
The Registered Nurse – Case Manager plays a pivotal role in coordinating and managing patient care throughout the healthcare continuum. This position focuses on ensuring patients receive appropriate care, optimizing health outcomes, and facilitating effective communication between patients, healthcare providers, and insurance companies. The RN Case Manager advocates for patients while promoting cost-effective and high-quality healthcare delivery.
Key Responsibilities
- Assess patient needs and develop individualized care plans in collaboration with the healthcare team.
- Coordinate care transitions, including hospital discharge planning and post-acute services.
- Facilitate communication among patients, families, physicians, and external providers.
- Monitor patient progress and adjust care plans as necessary to meet health goals.
- Provide education and resources to patients and families to support self-care and disease management.
- Ensure compliance with regulatory requirements and organizational policies.
- Document all case management activities accurately and timely in the electronic medical record system.
- Collaborate with insurance providers to manage authorizations and coverage issues.
- Participate in quality improvement initiatives related to case management.
Required Qualifications
- Current Registered Nurse (RN) license in the state of practice.
- Bachelor of Science in Nursing (BSN) preferred.
- Minimum of 2 years clinical nursing experience, preferably in acute care or case management.
- Strong organizational, communication, and problem-solving skills.
- Proficiency with electronic health records (EHR) and case management software.
- Basic Life Support (BLS) certification.
Preferred Qualifications
- Certification in Case Management (CCM or ACM) highly desirable.
- Experience with utilization review, discharge planning, or care coordination.
Certifications
- Registered Nurse (RN) License – active and in good standing.
- Basic Life Support (BLS) – required.
- Certified Case Manager (CCM) or Accredited Case Manager (ACM) – preferred.