Job DescriptionThe Registered Nurse (RN) Case Manager provides care coordination which emphasizes positive partnerships with nursing, physicians and other key disciplines in order to pace the care for outcomes while meeting core measures within the appropriate level of care. The RN Case Manager provides discharge planning by collaboratively determining level of care needs beyond acute care, providing decision support to patients and families and physicians, managing patient and family expectations and ensuring a smooth transition to the next level of care and services. The RN Case Manager performs utilization review with a high level of expertise by using criteria that demonstrates medical necessity to achieve reimbursement for services and ensuring appropriate utilization of hospital resources.
Required Skills- Excellent verbal, written, and organizational skills required.
- Ability to follow chain of command.
- Knowledge of medical terminology and current third party payor reimbursement methodologies.
- Self-motivated and results oriented.
- Must be able to demonstrate sound decision making and prioritization skills.
- Proficiency with main-frame and personal computers.
Required ExperienceRequired:- Maintain an active California RN License.
- Obtain ACM (Accredited Case Manager) or CCM (Certified Case Manager) within 3 years of hire.
- Minimum of 5 years hospital nursing experience
Preferred:- BSN or MSN degree
- CCM or ACM (Certified Case Manager, Accredited Case Manager)
- Previous experience in case management
