RN-Case Manager

POSITION TITLE: 206- RN Case Manager
LOCATION: Hospital Setting 
REPORTS TO: Director of Nursing
REVISION DATE: May 2026
QUALIFICATIONS:

• EDUCATION: Minimum high school diploma or equivalent required for all positions (may be allowed to sign a GED agreement to obtain within 6 months).
•     REQUIRED: Associate of Science in Nursing (RN)
•     PREFERRED: Bachelor of Science in Nursing (BSN)
• EXPERIENCE: N/A
•     REQUIRED:
•     PREFERRED: 
• OTHER REQUIREMENTS OR LICENSURE: BLS certification or obtains within six months of hire. ACLS and PALS provider strongly encouraged.

JOB DESCRIPTION: 
The job description reflects the general details considered necessary to fulfill the essential job functions and shall not be construed as all-inclusive of all work requirements inherent in this position. Other specific job-related knowledge and skills may be required. All employees subject to an annual performance evaluation based on the duties and responsibilities of this position. 

PHYSICAL DEMANDS & WORKING ENVIRONMENT: Usual working space is a well-ventilated area. Requires standing, walking, turning, bending, stooping, and lifting. Clear speech to communicate effectively with customers (e.g. patients, families, and other team members). Fine and gross motor skills. Environment may be stressful at times, therefore ability to work under stressful conditions is necessary. Lifting up to 50 lbs may be required, anything over 50 lbs should be a team lift or with the use of a lifting aid. Also subject to bloodborne pathogens at all times in patient care. May have occasional exposure to radiation during radiology procedures and to dangerous chemicals (cleaning and disinfecting agents).
COMPLIANCE AND REGULATORY EXPECTATIONS: All employees are expected to conduct themselves in a manner that upholds the highest standard of integrity, ethical behavior, and regulatory compliance. As a condition of employment, employees must adhere to:
· OCH Code of Conduct
· OCH Policies and Procedures
· Scope of Practice within License/Certification.
· HIPAA and HIPAA Security Confidentiality Standards
· Workplace Safety
· Mandatory Training
· Annual Compliance Education

ESSENTIAL JOB FUNCTIONS & KEY RESPONSIBILITIES: 
•    The RN Case Manager will provide the following functions in their daily role: utilization review, discharge planning, and care coordination for all levels of patient care in the facility.
•    Admission reviews for both federal and non-federal patients utilizing approved criteria.
•    Conducting continued stay reviews for both federal and non-federal patients utilizing approved criteria.
•    Application of Condition Code 44 per CMS guidelines.  
•    Demonstrates knowledge of various levels of care offered in the facility. These include the following: Acute/Inpatient, Observation, Outpatient Surgery Observation, Swing Bed, Critical Care and IVT.
•    Demonstrates effective critical thinking skills and problem solving with difficult patient situations to foster positive outcomes. 
•    Maintains all required documentation and retention of records as outlined in facility policies.
•    Identification of potential abuse and neglect and compliance with reporting standards.
•    Demonstrates knowledge of regulatory standards that apply to the area of practice in Case Management. 
•    Effective communication with staff, physicians, patients, families and visitors and all community agencies.
•    Performs admission assessments on patients of Ohio County Healthcare and initiates discharge planning at the point of assessment. Risk assessment performed for potential environmental hazards to patient.
•    Assessment of all Private Pay patients and assistance with resource navigation.
•    Understands and maintains compliance with the MOON notice per CMS guidelines.
•    Understands and maintains compliance with the Important Message from Medicare per CMS guidelines.
•    Understanding of Medical necessity precertification process for outpatient infusion and injection patients.
•    Maintains strong working relationships with Community Health, Welfare and Social agencies.
•    Participates in opportunities for continuing education and professional self-development.
•    Maintains a current license in the state of Kentucky.
•    Assures proper and timely documentation in patient medical records.
•    Serves as a liaison between Ohio County Healthcare and community agencies on behalf of the patient to provide continuity of care after facility discharge. 
•    Maintains confidentiality in all patient records and interactions. 
•    Responds promptly to all referrals.
•    Attends regularly scheduled meetings.
•    Observes personal hygiene and dress code as outlined in the Ohio County Healthcare personnel policies.
•    Is accountable for ensuring patient safety during the course of performing all duties.
•    Schedules and notifies all disciplines, patients and their families of Swing Bed Care Conferences.
•    Facilitates and documents all Swing Bed Care Conferences.
•    Participates in New Employee Orientation to educate on abuse and neglect.
•    Actions are consistent with Ohio County Healthcare’s purpose, vision, and values.
•    Adheres to Ohio County Healthcare’s legal and compliance program. 
•    Early identification and notification of Network for Hope if applicable.
•    Understanding of role in emergency situations in the facility.
•    Demonstrates an understanding of Policy Tech and OCH Common Drive.
•    Demonstrates an understanding of Interpreting Services.
•    May be requested to be member of QI team.
•    Involvement in the emergency department to help facilitate appropriate admission, discharges and transfers.
•    Assistance with reporting data as applicable as specific roles and responsibilities.

QUALIFICATIONS:

• EDUCATION: Minimum high school diploma or equivalent required for all positions (may be allowed to sign a GED agreement to obtain within 6 months).
•     REQUIRED: Associate of Science in Nursing (RN)
•     PREFERRED: Bachelor of Science in Nursing (BSN)
• EXPERIENCE: N/A
•     REQUIRED: 
•     PREFERRED: 
• OTHER REQUIREMENTS OR LICENSURE: BLS certification or obtains within six months of hire. ACLS and PALS provider strongly encouraged.