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RN Case Manager

Prime Healthcare
Gadsden, USA
Part-time
Entry · 1+ years experience
Onsite
Discovered 1 months ago
Milliman CriteriaInterQual CriteriaJiva

Full Job Posting

Location

  • Riverview Regional Medical Center – Gadsden, AL
  • We are seeking a n RN Case Manager , also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager . An RN Case Manager will oversee and coordinate patient care from admission through discharge to ensure quality, cost-effective outcomes. They assess patients’ needs, develop care plans, and collaborate with physicians, nurses, social workers, and other providers to manage care transitions. RN Case Managers also conduct discharge planning, utilization review, and helping patients navigate insurance and healthcare systems.

Essential Duties and Responsibilities (includes, but not limited to)

  • Patient Assessment: e valuate patients’ medical, psychosocial, and discharge needs upon admission and throughout their stay
  • Care Coordination: d evelop and implement individualized care plans in collaboration with the healthcare team to ensure effective treatment and timely interventions
  • Discharge Planning: c oordinate safe and appropriate discharge plans, including referrals to rehab, home health, or long-term care facilities
  • Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays
  • Patient and Family Education: h elp patients and families understand care plans, post-discharge instructions, and available resources
  • Advocacy: a dvocate for patient needs and preferences, ensuring care is aligned with their goals and values
  • Before we go any further, we do have some deal-breakers. You must have:
  • Valid State RN License
  • BSW or other Bachelor degree in a related field
  • Current CCM or obtained within 6 months of hire
  • Experience and knowledge in basic to intermediate computer skills
  • Behavioral Violence Prevention Training within 3 months of hire and maintain current
  • Additional Qualifications That Are a Plus:
  • Minimum 5 years of acute care experience
  • At least one-year experience in case management, discharge planning or management
  • Current BLS (AHA) certificate
  • Knowledge of Milliman Criteria and InterQual Criteria
  • Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/
  • #LI-MP1
  • BCBS of Alabama interqual Jiva experience required
  • Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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