RN Case Manager

Job Summary

The RN Case Manager plays a critical role in optimizing patient care and resource utilization. Responsibilities include assessing, planning, implementing, coordinating, monitoring and evaluating comprehensive care plans to meet individual health needs, focusing on quality patient outcomes and cost‑effective delivery. The role may cover general medical case management or specialize in high‑acuity or high‑cost areas such as high‑risk obstetrics, neonatal care, chronic disease management, or mental health support (excluding Behavioral Health).

Bachelor’s degree in Nursing preferred.

Registered Nurse (RN) with current active state license in good standing in the state(s) where duties are performed. Case‑management certification required. If not obtained prior to hire, must obtain a URAC‑recognized certification (CCM, ACM, or RN‑BC) within 3 years.

Minimum four years of clinical practice in at least one of the following: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.

• Administrative Process
• Affinite CM
• Affinite UM
• CCI Edits
• Collaborative Communications
• Critical Reasoning
• Cross‑Functional Planning
• Customer Relationship Management (CRM)
• Customer Service Workstation
• Deductive Reasoning
• Five9
• Information Security
• Interpersonal Relationship Management
• Microsoft Excel
• Microsoft Office
• Microsoft Outlook
• Microsoft Power Point
• Needs Assessment
• Oral Communications
• Problem Sensitivity
• Researching
• Sound Judgment
• Support Coordination
• Written Communication

• Assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs using plan benefits and community resources, ensuring cost containment.
• Other duties as assigned.
• Practices nursing within scope of licensure, adheres to policies, procedures, regulations, URAC standards, and state regulations; makes evidence‑based decisions for compliance, appropriate level of care, and patient safety.
• Provides specialized education and knowledge on disease‑specific conditions as needed.
• Stays current with medical and surgical procedures, products, services, drugs, and health‑care delivery trends.
• Serves as a liaison to facilitate collaboration among patients, families, physicians, discharge planners, home‑care providers, and ancillary providers to promote quality, cost effectiveness, accessibility, and appropriate service levels.
• Works proactively with referrals to identify appropriate candidates for case management, explains services, secures voluntary agreement, and maintains a minimum patient caseload in a timely manner.