Rn Case Manager

The RN Case Manager in this position has overall responsibility for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.

RN Case Manager Responsibilities:
Medical necessity screening
Care coordination
Discharge planning
Facilitating multi-disciplinary patient care conferences
Managing concurrent disputes
Making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST)
Referring complex social issues to Social Service
Communicating with patients and their families about the plan of care
Collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy)
Participating in weekly Complex Case Review
Arranging for post –discharge patient education
Clear, complete and concise documentation in eCCM
Maintaining accuracy of patient demographic and insurance information
Identifying and documenting potentially avoidable days
Identifying and reporting over and under utilization

Qualifications:

Education:

B.S.N. preferred, at least 5 year's bedside nursing experience required

Certification/License:
Current Professional Nurse License issued and/or recognized by Board of Nurse Examiners for the State of Texas
CCM or ACMA preferred

Experience:

Acute care Hospital Case Management Experience required;
Must have experience with Inter Qual critieria application

5+ to 7 years experience

Minimum Education - Bachelor's Degree

All your information will be kept confidential according to EEO guidelines.