Registered Nurse- Case Manager

Primary Responsibilities/Accountabilities:
Comprehensively plans for case management services for a targeted patient population. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Works with physician, Social Worker and interdisciplinary team to facilitate clinical pathways and achievement of desired treatment outcomes. Promotes interdisciplinary collaboration and champions service excellence. Works collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care.

Required qualifications:

• Bachelor's Degree required for RN Clinical Audit and Denial Care Manager: Nursing.

• RN Clinical Audit & Denial Care Manager-Unit Educator

• 1 year experience as a Case Manager in a hospital setting, managed care setting or clinical setting.

• Experience with the use of nationally recognized medical necessity screening tools.

• RN Clinical Audit and Denial Care Manager

• Significant experience in the healthcare field, including 3 years of Utilization Review/Case Management experience in an acute care or managed care setting.

• 2 years of experience in the denial management process preferred.

• Experience in the application of medical necessity screening criteria tools (MCG and/or InterQual).

• RN Case Manager Auditor

• 1 year experience as a Case Manager in a hospital setting, managed care setting or clinical setting.

• Experience with the use of nationally recognized medical necessity screening tools.

Preferred qualifications:

• Bachelor's Degree in Nursing/healthcare related field.

• 3 years Direct patient care experience in an acute care hospital in a leadership role.

• Case management or utilization management experience.