Case Manager Registered Nurse (RN)

A skilled Case Manager Registered Nurse (RN) coordinates and manages patient care, ensuring timely, effective, and cost-efficient healthcare services across various settings.

Key Responsibilities:

• Conduct comprehensive assessments of patients' medical, psychosocial, and financial needs to develop individualized care plans.
• Coordinate and facilitate care transitions across multiple healthcare settings, ensuring continuity, resource utilization, and adherence to treatment plans.
• Collaborate with physicians, healthcare providers, and insurance companies to authorize treatments, secure necessary services, and ensure compliance with clinical guidelines.
• Evaluate patient progress, monitor outcomes, and adjust care plans based on evolving needs and goals.
• Educate patients, families, and caregivers on disease management, treatment options, and available resources to support recovery and self-care.
• Advocate for patients to ensure they receive appropriate services and that care is delivered efficiently and effectively.
• Facilitate communication among healthcare providers, patients, and insurance companies to resolve barriers to care.
• Assist patients with obtaining necessary medical equipment, medications, and follow-up care to ensure successful transitions post-discharge.
• Track healthcare costs, utilization of services, and outcomes, contributing to cost containment strategies and improved care delivery.
• Monitor and ensure compliance with healthcare regulations, insurance policies, and external mandates related to case management.
• Participate in quality improvement initiatives, utilizing evidence-based practices to enhance patient care.
• Provide guidance and support to patients and families navigating complex healthcare systems.

Qualifications:

• Education: Bachelor of Science in Nursing (BSN) preferred; Associate Degree in Nursing (ADN) accepted.
• Licensure:
  • Valid Registered Nurse (RN) license in the state of practice.
• Certification:
  • Case Management certification (CCM) preferred.
  • Basic Life Support (BLS) certification required.
• Experience: Previous experience in case management, care coordination, or clinical nursing, particularly in medical-surgical, home health, or specialized units.