RN Case Manager

Registered Nurse (RN) Care Manager

The Registered Nurse (RN) Care Manager will:

• Conduct a comprehensive assessment and develop thoughtful plans to implement, coordinate, monitor, and evaluate healthcare services tailored to meet each individual’s specific needs in a cost-effective manner.
• Perform utilization reviews to assess the appropriateness and medical necessity of healthcare services for patients, while fostering strong relationships with payers to ensure compliance and alignment.
• Act as a patient advocate to guide patients through the complex healthcare system, ensuring their preferences and rights are respected and helping them access appropriate care or coverage.
• Facilitate coordinated patient care by collaborating with patients, their families, healthcare staff, physicians, Advanced Practice Provider (APPs) and community services, all aimed at promoting quality care.
• Incorporate cultural competence and awareness of Social Determinants of Health (SDOH) into assessment and care plan development to ensure a holistic approach to patient well-being.
• Take the lead on discharge planning and care coordination initiatives, with the goal of minimizing readmissions.
• Work closely with interdisciplinary teams to create and refine patient-centered care plans.
• Regularly monitor key performance indicators (KPIs), such as length of stay and readmission rates, to ensure optimal service delivery.
• Uphold stringent adherence to guidelines established by CMS, the Joint Commission, and all relevant payer requirements.

Qualifications:

• Professional Registered nurse with current North Carolina license (BSN preferred).
• Current BLS Healthcare Provider certification.
• Three years clinical experience in a health care facility with knowledge base of clinical nursing principles.
• Case Management Certification (CCM), Accredited Case Manager (ACM) and/or Health Care Quality and Management (HCQM) certification preferred.
• Knowledge of current trends and issues related to utilization and case management principles related to the hospital practice setting.
• Computer experience.
• Evidence of participation in ongoing continuing education programs.