Case Manager Registered Nurse

About This Role

This Registered Nurse (RN) Case Manager position is responsible for comprehensive planning for case management, care transitions, and discharge planning for a targeted patient population. The role collaborates with physicians and the interprofessional healthcare team to facilitate quality patient care and ensure appropriate medical necessity for reimbursement.

Responsibilities

• Comprehensively plan for case management, care transitions, and discharge planning for a targeted patient population
• Collaborate with physicians and the interprofessional healthcare team to facilitate compassionate, efficient, quality care
• Hold joint accountability with the social worker for discharge planning and continuity of care
• Assure that admission and continued stay are medically necessary for reimbursement
• Communicate clinical information to payors to ensure reimbursement
• Assess all patients timely and thoroughly
• Participate in daily Care Coordination Rounds (CCR) and identify barriers to efficient patient throughput
• Initiate and facilitate referrals for home health care, hospice, and durable medical equipment
• Manage assigned patients in Observation Status, informing physicians of timely disposition options
• Perform medical necessity review using nationally recognized screening guidelines

Requirements

• RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure
• Three years hospital nursing clinical experience
• Knowledge of Medicare, Medicaid and Managed Care requirements
• Proficiency in speaking, reading, and writing the English language
• Ability to effectively communicate with patients, physicians, family members and co-workers

Qualifications

• Graduate of an education program approved by the credentialing body for required credential(s); Bachelor's degree preferred
• Three years hospital nursing clinical experience

Nice to Have

• Bachelor's degree
• Case management experience
• Knowledge of community resources, healthcare financial and payor requirements/issues, and eligibility for state, local and federal programs

Skills

* Required skills