Job Type

Full-time

Description

JOB SUMMARY:

The Concurrent RN Care Manager is responsible for concurrent utilization review, care coordination, and discharge planning for inpatient members within a managed care environment. This role serves as a clinical resource to care management staff, supports compliance with regulatory and health plan requirements, and collaborates with providers, hospitals, and interdisciplinary teams to ensure medically necessary, cost-effective, and quality care.

The position performs medical necessity reviews using established criteria, monitors length of stay, facilitates transitions of care, and identifies opportunities to improve outcomes and reduce avoidable utilization.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: Graduate of an accredited Registered Nursing program.

Preferred: Bachelor of Science in Nursing (BSN).

Experience

Minimum: Three (3) years of clinical nursing experience; 1-2 years in utilization management, case management, or managed care.

Preferred: Experience in a health plan, MSO, IPA, or acute setting with utilization review responsibilities.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Current State Registered Nursing License

Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.

Skills, Knowledge & Abilities
• Knowledge of utilization management standards (CMS, DMHC, InterQual/Milliman)
• Strong clinical assessment and critical thinking skills
• Understanding of managed care and value-based care models
• Excellent written and verbal communication skills
• Ability to manage multiple cases and meet regulatory deadlines
• Proficiency with electronic medical records (EMR) and Microsoft Office applications
• Ability to work independently and collaboratively in a fast-paced environment
• Strong organizational and time management skills

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this position, with or without reasonable accommodation. The role primarily involves sedentary work, including extended periods of sitting, computer use, and communication. The employee may occasionally be required to stand, walk, bend, and lift items up to 20 pounds. The position requires the ability to review detailed medical documentation, perform data entry, and maintain sustained concentration and attention to detail. The employee must be able to communicate effectively through verbal, written, and electronic means, including phone and video communication. Occasional travel to healthcare facilities or office locations may be required based on business needs.

PAY RANGE

$85,000 - $100,000 / annually

Salary Description

$85,000 - $100,000 / annually