Responsibilities

The RN – Case Manager is responsible for the overall coordination of care for an assigned caseload. Concurrent and retrospective clinical review of inpatient medical records to evaluate the utilization of acute care services. Specific reviews are determined both internally and by requirements/requests of external payers or regulatory agencies and play a significant role in obtaining reimbursement for acute care services. Goal is to collaborate with patients, families and healthcare providers to promote health and manage illness. The RN – Case Manager facilitates the use of assessment, coordination and education to achieve quality patient care outcomes while coordinating interdisciplinary, comprehensive and cost-effective care across the continuum.
Needs knowledge of utilization review, case management, DC planning, care coordination and precertification of hospital days and post-acute care services. Prefer 3–5 years of acute care hospital experience and 2 years of acute care case management experience.