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:
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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/
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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
About Prime Healthcare
Hospitals & Health Systems60000 employeesFounded 2001
Private hospital system delivering community-focused healthcare services.