The RN Case Manager 1 provides discharge planning and continuity of care for assigned patients in acute and post-acute settings. Provides coordination of services and acts as key liaison between patients, families and interdisciplinary healthcare members. Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely regulatory compliance and facilitation of precertification and payer authorization processes when indicated. Actively participates in clinical performance improvement activities.
As a Registered Nurse (RN) Case Manager I, you will actively participate in clinical performance improvement activities. To help achieve our mission, you will provide discharge planning and continuity of care for assigned patients in acute and post-acute settings. Your understanding of pre-acute and post-acute resources is expected. Providing coordination of services and acting as key Liaison between patients, families and interdisciplinary healthcare members is of vital importance. Using utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities is essential. Taking ownership for the timely regulatory compliance and facilitation of precertification and payer authorization processes when indicated is required.

Job Responsibilities

• Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members.
• Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities.
• Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed.
• Identifies at risk populations by using approved screening tools and following established reporting procedures.
• Participates in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary healthcare team members.

Requirements:

• Education: Bachelor of Science in Nursing (BSN). If candidate has ASN, a BSN must be obtained within 2 years of employment
• Experience: 1 year of case management or clinical experience
• License: Active RN license in VA
• Certification: BLS through the American Heart Association