RN Case Manager
- JOB RELATIONSHIPS
- Reports to the Director of Research and Innovation in collaboration with the CNO/VP of Patient Care
Services
- Reports to the Director of Research and Innovation in collaboration with the CNO/VP of Patient Care
- DEFINITION OF POSITION
- The Registered Nurse (RN) Care Manager will:
- Conduct a comprehensive assessment and develop thoughtful plans to implement, coordinate, monitor,
and evaluate healthcare services tailored to meet each individual's specific needs in a cost-effective
manner. - Perform utilization reviews to assess the appropriateness and medical necessity of healthcare services
for patients, while fostering strong relationships with payers to ensure compliance and alignment. - Foster strong relationships with payers to ensure compliance and alignment
- Act as a patient advocate to guide patients through the complex healthcare system, ensuring their
preferences and rights are respected and helping them access appropriate care or coverage - Facilitate coordinated patient care by collaborating with patients, their families, healthcare staff,
physicians, Advanced Practice Provider (APPs) and community services, all aimed at promoting quality
care. - Incorporate cultural competence and awareness of Social Determinants of Health (SDOH) into assessment
and care plan development to ensure a holistic approach to patient well-being - Take the lead on discharge planning and care coordination initiatives, with the goal of minimizing
readmissions. - Work closely with interdisciplinary teams to create and refine patient-centered care plans.
- Regularly monitor key performance indicators (KPIs), such as length of stay and readmission rates, to
ensure optimal service delivery. - Uphold stringent adherence to guidelines established by CMS, the Joint Commission, and all relevant
payer requirements.
- Conduct a comprehensive assessment and develop thoughtful plans to implement, coordinate, monitor,
- The Registered Nurse (RN) Care Manager will:
- QUALIFICATIONS
- Professional
- Registered nurse with current North Carolina license (BSN preferred).
- Current BLS Healthcare Provider certification.
- Three years clinical experience in a health care facility with knowledge base of clinical nursing principles
- Case Management Certification (CCM), Accredited Case Manager (ACM) and/or Health Care Quality and Management (HCQM) certification preferred
- Knowledge of current trends and issues related to utilization and case management principles related to the hospital practice setting.
- Computer experience
- Evidence of participation in ongoing continuing education programs.
- Professional
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