RN Case Manager

ID: Shift: Day 5x8-Hour (08:00 - 16:30) Description: Job Description: Coordinates the utilization management resource management discharge planning post-acute care referrals and care facilitation. Oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department. Strives to promote patient wellness improved care outcomes efficient utilization of health services and minimized denials of payment among a patient population with complex health : BLS CA License 2 years expShift Details: 5x8s 0830-1700 minimum 2 weekend shifts per month if floated will only work in CM Modified Time:5/18/2026 12:00:00 AM Account Manager: Quinton Reed Account Manager Email: COVID-19 Vaccine: Unknown Flu Vaccine: Unknown Submittals:High Job Requirements & Qualifications Previous Charge Experience : Required Years of Experience : 1 Patient Ratio Experience : 20 or more Charting System Experience : - Charting System Name : Any Community Hospital Experience : Preferred LTAC Experience : Preferred Trauma Level I Experience : Preferred Trauma Level II Experience : Preferred Travel Experience Required : Yes Certifications : BLSSkills : Acute Hospital Long Term Acute Care/Rehab/Skilled Nursing Admission Criteria Care coordination Discharge Planning Utilize InterQual Criteria Utilize Milliman Guidelines Admission Criteria Appeals and Denials Concurrent Review Continued Stay Reviews Medical Necessity Retrospective Review Utilize InterQual Criteria Utilize Milliman Guidelines CMS: Centers for Medicare and Medicaid Services CPT (Current Procedural Terminology) coding and billing Department of Health DRG (Diagnosis Related Groups) HEDIS (The Healthcare Effectiveness Data and Information Set) Measures HIPAA guidelines (Health Insurance Portability and Accountability Act) ICD 10 Coding NCQA (National Committee for Quality Assurance) OSHA The Joint Commission/ Core Measure/National Safety Goals Workers Compensation Unit Details Staffing & Scheduling Scheduling Type : - Patient Ratios Days : 20 Patient Ratios Nights : 0 Patient Ratios Weekends : - Float Required : Float between inpt and ED unit coverage Call Required : - Weekend Coverage : True Number of Weekend Shifts Per Contract : 3 weekend days per 28 day cycle. Pre-Approved Time Off : one Orientation Hours : 80 Facility & Patient Care Details Patient Age Groups : Adults Geriatrics Daily Census : 100-120 Number of Visits Per Day : 50 Number of Rooms : 120 Number of Beds : 120 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