What are the responsibilities and job description for the RN Case Manager position at Carteret Health Care?
JOB RELATIONSHIPS
Reports to the Director of Research and Innovation in collaboration with the CNO/VP of Patient Care
Services
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.
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.
Salary.com Estimation for RN Case Manager in Morehead, NC
$72,574 to $87,783
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