RN Case Manager

ID: Shift: Day 5x8-Hour (08:00 - 16:30) Description: CASE MANAGER RN NEEDED - 5/8sEvery Other WeekendCertification Requirements:CA RN LICENSEBLSExperience: 5 Years of RN Case Management experience**PER THE MANAGER MUST HAVE Inpatient Acute Case Management (Case Manager Hospital experienceJOB DUTIES: Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician Utilization Manager Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health access to care and appropriate utilization of resources balanced with the patients self determination while coordinating in a timely and integrated fashion. He/She collaborates with patients families physicians the interdisciplinary team nursing management quality ancillary services third party payers and review agencies claims and finance departments Medical Directors and contracted providers and community resources. If assigned to the Emergency Department the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary ACCOUNTABILITIES:Patient Initial and Continued Assessment. Reviews initial physician admission care plan. Gathers additional medical psychosocial and financial information from the patient/family interview medical record assessment physicians and other health care providers. Determines moderate or high risk level for readmission. Conducts a screening for ancillary supportive services including but not limited to Palliative Care Services needs. Functionally supervises and actively leads the health care team in developing comprehensive cost-effective care coordination plans that meet the clinical needs of our patients. Identifies and refers quality and risk management concerns to appropriate level for patient safety reporting and trending. Directs and oversees the Case Management Assistants to determine preferences for post-acute care Management. Reviews medical record to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination and assignment. Works with Attending Physicians to confirm necessary documentation to support level of care (LOC). Expedites transition planning for patients who no longer require acute level of care. Monitors length of stay (LOS) and outliers requiring additional resources and/or focus. Collaborates with financial counselor for delivery of inpatient stay denials. Assures delivery of Medicare Important Message within 48 hours of discharge/transition and no less than 4 hours of actual discharge/transition. Actively participates in patient rounds following the standard work as developed and collaborates with interdisciplinary team to assure timely transition. Follows policies and procedures for Physician Advisor referrals. Utilizes appropriate escalation process when discussing level of care (LOC) requirements with providers. Consistently documents in the EHR and other electronic software. Maintains current knowledge of CMS and Joint Commission Transitions of Care requirements Conditions of Participation (COPs) and other regulatory requirements. Effectively follows Observation patients re-evaluates and collaborates with attending physician for admission or transition to appropriate level of care for the Coordination/ Care Transitions. Formulates a transition plan after reviewing available/appropriate care options and obtaining input and collaborating with the patient/family and physician health care team payers and community based support services. Performs documents and communicates assessment findings to health care team. Screens 30-day readmissions; reviews previous hospital record confers patient/family and with interdisciplinary team to create an effective and realistic transition plan. Proactively identifies barriers to care progression and transition and works with multi-disciplinary team to resolve timely. Addresses complex clinical and social situations efficiently in order to avoid unnecessary admissions improper level of care utilization and delays in transition. Reviews and modifys plan of care. Assures timely transition to lower level of care. Assesses the need for follow up appointments and when applicable communicates to patient/family prior to transition. Assures necessary paperwork for post-acute transfers to comply with state and federal regulatory requirements. Identifies ED high utilizers and makes appropriate care plans and referrals to community resources. Identifies patient and families with complex psychosocial issues (social determinants of health) and refers to health care team as appropriate. Communicates with Financial Counselors regarding uninsured underinsured and makes referrals as appropriate. Makes appropriate and timely referrals and completes documentation to comply with state and federal regulatory requirements. Identifies patients appropriate for case management intervention by reviewing the electronic health record (EHR) and meeting with patients and collaborating with staff and physicians Follows locally determined resources and workflows for patient participates in ongoing department operations. Identifies new system processes protocols and/or methods to improve practices. Actively contributes to the creation of cost effective practices that ensure the best patient/provider experience effective resource utilization and safe outcomes. Effectively communicates with Care Management colleagues for safe transitions. Actively aware and manages all communications (email KDS Policies & Procedures Handoffs and other) and participates in all department meetings. Uses effective interpersonal and communication skills to promote customer service with internal and external customers. Develops and maintains positive productive and professional relationships with the healthcare team and representatives of community agencies. Relates with tact and respect to all customers with diverse cultural and socioeconomic backgrounds without personal judgment. Be a positive participant actively engaged in all department operations. Willingly provides and accepts direct constructive feedback to and from colleagues and the leadership team. Actively uses effective communication skills with colleagues to resolve issues in a timely manner. Modified Time:5/11/2026 12:00:00 AM Account Manager: Quinton Reed Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Submittals:Low Job Requirements & Qualifications Previous Charge Experience : Preferred Years of Experience : 2 Patient Ratio Experience : 10 Charting System Experience : Preferred Charting System Name : Epic Community Hospital Experience : Preferred LTAC Experience : Preferred Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : Yes Certifications : BLS*Skills : Acute Hospital Admission Criteria* Admission Criteria* Appeals and Denials* Appeals and Denials* Care coordination CMS: Centers for Medicare and Medicaid Services* Concurrent Review* Concurrent Review* Continued Stay Reviews* Continued Stay Reviews* Disability case management* Discharge Planning DRG (Diagnosis Related Groups)* Emergency Department* Home Health* Hospice* ICU* MS* Needs Assessment/ Order DME* Prior Authorizations* SDU/PCU/IMC/Obs* Utilize InterQual Criteria* Utilize InterQual Criteria* Utilize Milliman Guidelines* Utilize Milliman Guidelines* screen any missing skills Unit Details Staffing & Scheduling Scheduling Type : Other Patient Ratios Days : -15 Patient Ratios Nights : - Patient Ratios Weekends : -25 Float Required : - Call Required : no Weekend Coverage : True Number of Weekend Shifts Per Contract : - Pre-Approved Time Off : one Orientation Hours : - Facility & Patient Care Details Patient Age Groups : Adults Geriatrics Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : - Special Procedures/Unit Details : - Special Equipment : - #Tier3 Travel Compliance RTO only one holiday will be approved Requires specific amount of exp - 2 yrs required for submission Must be available to go in for lab work within 3-5 days of signing Valid State License (required at time of submission) 50 miles travel requirement; Locals accepted at local rate please confirm that locals are aware that they are accepted at a lower BR Copy of Certifications All certs must be AHA and in hand at the time of the submittal Specific Charting Exp. Required - Epic experience preferred Background Policy to be noted prior to submission please state if they have any BG hits or DUIs. They just need to know prior to submission Return Staff Policy - gone 1 yr to return as traveler Work History Verification: 7-Year Work History Verification Required for all candidates. Candidates must provide accurate work history information going back 7 years from their start date and may also be required to provide documentation or contacts for the verifications if we are unable to verify any positions. Modules: Modules are non-billable average 1-5 hours spent on modules and are factored in NBO. Any time spent on modules exceeding the 16 NBO hours are billable Modules are completed during orientation and module hours vary by specialty Modules are recorded through e-learning Submittal Details: #Tier3 Travel ComplianceRTO only one holiday will be approvedRequires specific amount of exp - 2 yrs required for submissionMust be available to go in for lab work within 3-5 days of signingValid State License (required at time of submission)50 miles travel requirement;Locals accepted at local rate please confirm that locals are aware that they are accepted at a lower BRCopy of CertificationsAll certs must be AHA and in hand at the time of the submittalSpecific Charting Exp. Required - Epic experience preferredBackground Policy to be noted prior to submission please state if they have any BG hits or DUIs. They just need to know prior to submissionReturn Staff Policy - gone 1 yr to return as travelerWork History Verification: 7-Year Work History Verification Required for all candidates. Candidates must provide accurate work history information going back 7 years from their start date and may also be required to provide documentation or contacts for the verifications if we are unable to verify any :Modules are non-billable average 1-5 hours spent on modules and are factored in NBO. Any time spent on modules exceeding the 16 NBO hours are billableModules are completed during orientation and module hours vary by specialtyModules are recorded through e-learning Guaranteed Hours: Contract Weeks:91