What are the responsibilities and job description for the Utilization Review Case Manager, RN - Lavonia, GA position at St. Mary's Health Care System?
The RN Case Manager (RN CM), works in collaboration with a multidisciplinary team by identifying and initiating discharge planning to accomplish the timely transition of patients to a post-acute hospital setting and to ensure patients progress along the continuum of care. RN CM facilitates patient transitions efficiently and in a cost-effective manner that ensures quality outcomes. RN CM utilizes established guidelines to support appropriate level of care throughout hospitalization in compliance with CMS and organizational utilization management requirements. RN CM helps to ensure medical necessity is met by regularly reviewing severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services.
Required Education, Experience and Certification/Licensure
A. Licensure/Certification/Registration: Current GA RN license. Case Management Certification preferred. BLS required.
B. Education: Must be a graduate of an accredited school of nursing, BSN recommended.
C. Experience: Minimum 3 years experience in nursing in a hospital setting; preferred 1 year in case management, utilization management, or discharge planning .
Required Skills and Abilities
1. Clinical and analytical skills necessary to facilitate collection of patient clinical information from medical record and to objectively apply various criteria as dictated by CMS.
2. Strong organization and prioritization skills.
3. Strong interpersonal and communication skills, including telephonic and electronic
4. Ability to concentrate and pay close attention to detail.
5. Computer Skills:
o Required: Basic keyboarding skills
o Preferred:
§ EPIC
§ Microsoft Word
§ Microsoft Teams
§ Microsoft Outlook
§ Microsoft Excel
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
