RN Case Manager

General Summary

Under the direction of the Director of Care Management, this position supports the physician and interdisciplinary team in facilitating patient care, with the objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions.

This position is accountable for managing the patient caseload and plans effectively to meet patients' needs, manage the length of stay, and promote efficient utilization of resources.

• Collaborate with Hospitalists and other disciplines coordinating care to impact length of stay and case mix.
• Manage discharge planning upon admission to develop a safe and appropriate transition to the next level of care.
• Coordinate communication with physicians.
• Support accurate clinical documentation.
• Identify and evaluate process improvement methodologies and outcomes of care.
• Facilitate pre-certification and payor authorization processes, including denials and appeals.
• Demonstrate compliance with regulatory requirements.

Degree in nursing required, BSN preferred. Professional skills include data entry into and retrieval from a managed care information system, and ability to interface effectively with physicians.

Minimum of one year experience in a managed care setting preferred, and a minimum of three to five years experience in medical, surgical, or acute care nursing.

Current State of Ohio nursing license. Certification in Case Management (CCM) preferred.

Work and move among all acute care nursing units. Manual dexterity to operate personal computers and standard office machines. Flexible work hours required throughout the year. General office working conditions.