RN- Case Manager w​/Utilization Review

Registered Nurse Non-Certified Case Manager

The Registered Nurse Non-Certified Case Manager works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures patient is progressing towards desired outcomes by monitoring care through assessments and/or patient records. Identifies and resolves barriers that hinder effective patient care. Actively involved in discharge planning process.

Minimum Qualifications:

• Required Montana Licensure (Registered Nurse)
• American Heart Association BLS
• Minimum of 2 years of nursing experience MUST HAVE UTILIZATION REVIEW EXPERIENCE
• Preferred Bachelor's Degree in Nursing
• 2 years of acute care hospital experience as a case manager

Essential Job Functions:

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for members.

Knowledge, Skills, and Abilities:

• Demonstrates sound judgement, patience, and maintains a professional demeanor at all times
• Ability to work in a busy and stressful environment
• Strong interpersonal, verbal and written communication skills
• Exercises tact, discretion, sensitivity and maintains confidentiality
• Computer applications, MS Office, EMR, internet applications and standard office equipment
• Ability to analyze, organize and prioritize work while meeting multiple deadlines
• Strong emotional intelligence, interpersonal and teamwork skills

Schedule Requirements:

This role requires regular and sustained attendance. The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts. On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements:

• Lifting (Repeatedly – 50 pounds)
• Sit (Occasionally)
• Stand (Repeatedly)
• Walk (Repeatedly)
• Climb (Rarely)
• Twist/Bend/Stoop/Kneel (Repeatedly)
• Reach Above Shoulder Level (Repeatedly)
• Push/Pull (Repeatedly)
• Fine-Finger Movements (Continuously)
• Vision (Continuously)
• Cognitive Skills (Continuously)
• Exposures (Continuously):
  Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases are caused by contact with patients in areas that may have contagious illnesses. Emotionally challenging situations, such as dealing with distressed patients or difficult family interactions.

Shift: Day Shift. 7:30am - 4:30pm, Weekend Rotations

Specialty Type:
Nursing

Sub Specialties:
Care Manager, Med-surg Adult

General

Certifications:

General Certifications(BLS/BCLS)