Rn Case Manager Job Description

Job descriptions
Healthcare and Medical

Job summary 1

The more health care changes, the more certain values count. Like quality, patient-centric care, compassion and a dedication to going the extra mile. As a RN Case Manager, you'll wear many hats and work in a variety of environments. But wherever you happen to find yourself, you’ll gain a profound sense of satisfaction knowing you’re helping to create a more efficient and effective health care system for everyone.

Duties & Responsibilities 1

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Visit members in their homes and/or other settings, including community centers, hospitals or providers' offices
Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
Assist members with the transition from a care facility back to their home
- Complete MMP required assessments and care planning
- This role involves approximately 80% travel and you’ll need to be comfortable dealing with a full range of in-home and facility-based environments. Most of the time you’ll work autonomously, so the ability to stay focused and motivated is essential.
- You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements & Skills 1

Current, unrestricted RN license
Access to reliable transportation
3+ years in clinical Case Management or Home Health experience
Intermediate Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
BSN
Certification in Case Management-CCM
- Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
- Experience in Home & Community based or Long Term Care services delivery
- Managed Care including Medicaid / Medicare

Job summary 2

The RN Case Manager provides, coordinates and directs the provision of home health nursing services and case management processes according to the assigned patient's individualized plan of care based on agency policies and procedures, through the competent application of nursing process.

Duties & Responsibilities 2

Demonstrates knowledge of home care and competency in discipline specific patient care skills, required by the care center for the provision of patient care.
Performs patient comprehensive assessments and collaborates with patient multi-disciplinary care team (PT, OT, ST, MSW, and paraprofessionals) and other health care professionals to develop/modify and implement an individualized patient plan of care as per physician orders that ensures quality, proper discharge planning and achieves desired outcomes and goals.
Implements appropriate nursing clinical programs and initiatives to achieve desired outcomes.
Utilizes a combination of agency resources and nationally recognized standards of practice to deliver high quality care and achieve excellent patient specific outcomes.
Makes referrals to other disciplines as indicated by the patient's identified needs or documents rationale for not doing so.
- Promotes and maintains patient health and independence through teaching and appropriate rehabilitative measures, assisting patients in learning appropriate self-care techniques. Advocates and ensures patient participation in care planning and goals of care.
- Supervises caseload including LPN's and Home Health Aides. Facilitates care coordination with PRN staff when care is provided for caseload.
- Completes documentation timely, accurately, and at the point of care, according to industry standards, conventions and guidelines, including OASIS assessments, SOC/Admissions, Recertifications, ABNs, subsequent visits, physician orders, care coordination etc.

Requirements & Skills 2

Current and unencumbered license to practice as a Registered Nurse specific to that state the employee is assigned to work for the company.
Nurse Licensure Compact (NLC) documents the following: The mutual recognition model of nurse licensure allows a nurse to have one license (in his or her state of residency) and to practice in other states (both physical and electronic), subject to each state’s practice law and regulation.
One (1+) year of clinical experience as a Registered Nurse (RN). If less than 1 year clinical experience as a RN, candidate must be approved by VP Clinical.
- Demonstrated knowledge of the appropriate skills for communicating with individuals of all ages. Excellent interpersonal skills including verbal and written communication skills.
- Demonstrates knowledge of Federal/State rules and regulations, ACHC standards, and other regulatory requirements.
- Valid Driver’s License.

Job summary 3

Are you a licensed RN who is interested in using your clinical expertise outside of a clinical or hospital setting? Do you pride yourself in examining all the details of a situation before making important decisions? Are you passionate about ensuring that all patients receive optimal types and levels of care? If so, please consider joining us as a RN Case Manager. This role is responsible for conducting clinical review of authorization requests to identify and determine appropriate types and levels of patient care. This role also facilitates referrals between health plan members, participants, primary care physicians and other health care providers.

Duties & Responsibilities 3

Utilize clinical judgment and knowledge of established standards to make coverage determinations based in individual member circumstances
Conduct prospective, concurrent, and retrospective medical reviews for coverage determinations of managed care members
Review medical records, conduct telephone assessments, and patient/nurse/physician interviews, and provide referrals to appropriate agencies, as needed
Investigate and facilitate all alternatives to services requested when specific requests cannot be authorized
Analyze data for case selection process utilizing resources such as claims, hospital discharge, pharmacy, and utilization management data as well as data supplied by other resources such as purchasers, member or caregiver, and practitioners
Care Management - establish objectives, goals and actions designed to meet patient’s needs and monitor the care plan to ensure effectiveness and appropriateness of services; practice conflict resolution strategies, as needed
- Obtain accurate and detailed clinical information from appropriate sources to facilitate clinical review of cases; maintain information for reporting purposes
- Maintain confidentiality and adhere to the professional standards and ethics of the healthcare field and managed care industry
- Serve as the medical liaison between contracting staff and case managers, interpreting contractual language to determine payment issues and collaborating with all parties to resolve contract issues based on medical appropriateness, as needed.

Requirements & Skills 3

Bachelor’s Degree in nursing or related field (will consider Associate’s Degree with experience)
State RN license
2-3 years of RN case management experience in a clinical and/or inpatient setting
Valid Driver’s license with the ability to travel, as necessary, within the designated service area
State RN license is preferred, or ability to obtain upon hire
Working knowledge of managed care as it relates to contracting in health insurance, per diems, DRG’s CPT and ICD-9 coding
- Exceptional customer service skills, including understanding the needs of culturally diverse populations, and ability to evaluate for literacy and literacy needs
- Strong written and verbal communication skills interacting with individuals internally and externally
- Strong independent, critical thinking skills to understand individual and operational problems and identifying appropriate solution(s)

Job summary 4

We have an opening for an RN Case Manager. The RN Case Manager will work collaboratively with physicians, nurse practitioners and other health care team members. The ideal candidate must be able to assess the needs of =patients and make decisions on appropriate interventions based on clinical knowledge and collaboration with other team members. RN Case Management experience in oncology is preferred, however, extensive RN oncology or case management experience will be considered.

Duties & Responsibilities 4

Triage's patient calls and handles patient issues/concerns in a timely, professional and courteous manner.
Discusses patient care issues with practitioners as needed.
Takes care of filling all appropriate medications through E-Scribe system in EMR.
Ensures all necessary documentation of interactions with patients is in the patient’s electronic chart.
- Monitors the fax machine and ensures all faxes are taken care of in a timely manner.
- Works with the intake/case manager secretary to assure all necessary documents are available to the physician at the time of initial consultation.
- Instructs patients according to their needs as directed by a provider.

Requirements & Skills 4

Associates of Science in Nursing required, Bachelors of Science in Nursing (BSN) is preferred.
Valid State Registered Nursing License is required.
Two years’ experience in oncology nursing and/or telephone triage is preferred.

Job summary 5

The RN Case Manager assures clinical appropriateness of services and efficient use of resources through collaboration with the entire health care team for acute care patients. The RN Case Manager is responsible for medical necessity review, discharge planning, and utilization review.

Duties & Responsibilities 5

Performs medical necessity reviews and initial assessment within 24 hours of patient admission.
Identifies and communicates changes in the patient’s plan of care to the health care team.
- Maintains detailed knowledge of community resources and process for referrals
- Completes all assigned UR tasks on a daily basis
- Documents inpatient record in a consistent and timely manner to include initial screenings and discharge plan.

Requirements & Skills 5

Graduate of an accredited school of Nursing. BSN preferred
Current licensure as a Registered Nurse in the State.
- Current BLS
- Minimum of 5 years of experience preferred, preferably in a hospital setting
- Case Management Certification highly preferred

Job summary 6

The RN Case Manager is responsible for providing clinical advice and education to patients via telephonic means. Offers intervention, counseling and support services which require clinical knowledge, judgment and nursing skill based upon principles of psychological, biological, physical and social sciences. Makes decisions based on his/her educational preparation, experience in nursing and clinical guidelines. Completes compliance and persistency program education and training with patients according to requirements. Provides quality patient care by assuring a smooth workflow within the department and acts as liaison between the patient and other departments. Serves as a clinical and educational resource to other departments and health care practitioners.

Duties & Responsibilities 6

Responds to and evaluates patient concerns and questions in a call center type setting, ensuring appropriate compliance with standards of practice
Completes appropriate forms/adverse event forms when necessary
Documents patient interventions in both pharmacy processing and patient care systems, consistently
Acts as clinical resource and works collaboratively with other departments to optimize patient outcomes
Maintains the knowledge of drug side effects and interactions
- Collaborate with supervisor or pharmacist to resolve complex issues or escalations, as needed
- Performs other duties and responsibilities as required
- You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements & Skills 6

Job summary 7

The RN Case Manager will need to be detail oriented in order to effectively carry out all administrative duties, as well as provide quality hands-on resident care. The successful candidate will bring a caring and positive attitude while enjoying to work in a fast-paced environment with a great team.

Duties & Responsibilities 7

Reviews and contributes to service plans.
Completes resident Health Evaluations.
Reviews incident reports and participates in corrective action plan development.
Provides first aid and emergency assistance while working within the community.
- Acts as a clinical resource to all Resident Services staff.
- Completes and supervises RN Delegation, as applicable by state law.
- Provides training programs as requested.

Requirements & Skills 7

2 years of Nursing experience, preferably with senior population.
Current, unencumbered RN license and graduate of accredited nursing program.
Knowledge of applicable regulations pertaining to assisted living or memory care residents a plus.
- Familiarity with older adult nursing care and the concepts of assisted living or memory care.
- Outstanding assessment skills.
- Current CPR card required.

Job summary 8

RN Case Manager is responsible to provide Utilization Review/Case Management approval during the admission process and to also provide clinical information as required to Insurance Companies at admission and during stay. This position will work closely with Revenue Cycle staff and Discharge Planning to assist in the review and acceptance into the sub-acute rehab program. RN Case Manager will coordinate the Quality Improvement monthly meetings and subsequent reports.

Duties & Responsibilities 8

Perform daily reviews of Inpatient/Observation stays to assure care meets current standards, that level of care is appropriate and apply federal Insurance Guidelines as applicable.
Communicate with Revenue Cycle Department regularly to ensure all requirements are met
Tracks and provides requested clinical information to insurance companies
Provides termination of benefits information to patients and family as applicable
Assist in the development of discharge plans, assuring that it is safe, financially reasonable, and consistent with the medical needs of the patient.
Assist in periodic evaluation of plan and recommend changes or adjustments
- Participates in patient care conferences
- Participates in the Discharge Planning meetings involving outside agencies
- Participates in the Swing Bed Care Planning Meetings

Requirements & Skills 8

Registered Nurse with current NYS License
Preferred experience with Utilization Review/Case Management
- BSN Preferred
- Familiar with agency support availability
- PRI certification or within six months of employment

Job summary 9

We are looking for nurses that want to make a difference in the lives of their patients and help them live each day to their fullest. We have a great opportunity for an RN Case Manager to work in collaboration with the Patient Care Coordinator and the Interdisciplinary Team in the planning, implementation and evaluation of patient care.

Duties & Responsibilities 9

Provide nursing care to hospice patients in their homes
Supervise LPNs and Hospice Aides
Assess patient and family needs to provide comprehensive plans of care
- Educate patients and caregivers
- Document patient status and communicate appropriate with Interdisciplinary team members and/or physicians
- Work with interdisciplinary team to achieve patient/family goals

Requirements & Skills 9

Be a graduate of an accredited nursing program and possess a valid RN license in the state employed.
- 1) Year of general nursing experience is preferred.
- Current CPR Certification.
- Licensed driver in the state employed with an automobile that is insured.

Job summary 10

We are looking for an RN Case Manager.

Duties & Responsibilities 10

Performs initial and ongoing nursing assessments
Triages patient care problems
Develops and maintains patient’s individualized plan of care
Performs specialized nursing skills related to palliative and end-of-life care related to managing discomfort and providing symptom relief
Consults with and educates the patient and caregiver regarding disease process, self-care techniques, end of life care, comfort measures, medication use and side effects
Provides psychosocial support to patients and families
- Provides preparation and support for patient’s death; pronounces deaths in accordance with state regulation, provides post mortem care
- Coordinates personal care, DME, and obtaining medications and medical supplies
- Provides supervision of care provided by CNAs and LVNs and homemakers

Requirements & Skills 10

Olivia Powell
Recruiting expert

Last updated Sep 24

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