About this role
The RN Case Manager facilitates care across a continuum by coordinating resources to help patients access care and achieve optimal health. The role ensures appropriate level of care based on medical necessity, supports safe discharge and throughput, and helps prevent avoidable readmissions through utilization and transition management.
Key Responsibilities
- Perform accurate medical necessity screening and submission for Physician Advisor review
- Coordinate care and transition planning assessment/reassessment
- Implement or oversee the transition plan to promote timely throughput and safe discharge
- Lead and facilitate multi-disciplinary patient care conferences
- Manage concurrent disputes and make appropriate referrals to other departments
Technical Overview
Case management focused on utilization management (medical necessity and denial prevention) and transition management (length of stay, readmission prevention, and patient satisfaction). Ensures compliance with state and federal regulatory requirements and TJC accreditation standards while coordinating multidisciplinary care conferences and referrals.
Ideal Candidate
The ideal candidate is a Registered Nurse with case management experience focused on utilization management and transition management. They are skilled in assessing patients for transition needs, coordinating resources to support timely throughput and safe discharge, and preventing avoidable readmissions while meeting TJC and regulatory compliance expectations.
Must-Have Skills
Registered Nurse (RN)utilization management supporting medical necessity and denial preventiontransition management promoting appropriate length of stay and readmission preventioncare coordination ensuring care is provided at the appropriate level of carecompliance with state and federal regulatory requirements and TJC accreditation standardsassessment for transition needs to promote timely throughputsafe discharge and prevent avoidable readmissions
Required Skills
care coordinationresource coordinationutilization managementmedical necessity screeningdenial preventiontransition managementreadmission preventionthroughput efficiencysafe discharge planningTJC accreditation standards compliancestate and federal regulatory compliancemulti-disciplinary patient care conferencesreferralspatient education
Hard Skills
care coordinationresource coordinationutilization managementmedical necessity screeningdenial preventiontransition managementreadmission preventionpatient satisfactionthroughput efficiencylevel of care determination based on medical necessityassessment for transition needssafe discharge planningTJC accreditation standardsstate and federal regulatory requirements compliancemulti-disciplinary patient care conferences facilitationmanaging concurrent disputesmaking appropriate referrals to other departmentseducation provided to physicianspatientsfamilies and caregivers
Soft Skills
cross-functional collaborationcommunication with physicianspatientsfamiliesand caregiversfacilitating patient care conferencespatient advocacyconflict handling in concurrent disputescoordinating care across teams
Certifications
Required
Registered Nurse (RN)
Keywords for Your Resume
Registered NurseRNCase ManagerRN Case Managercare along a continuumresource coordinationutilization managementmedical necessitydenial preventiontransition managementreadmission preventioncare coordinationthroughput efficiencysafe dischargeTJC accreditation standardsstate and federal regulatory requirementsmulti-disciplinary patient care conferencesconcurrent disputesreferralseducation provided to physicianspatientsfamilies and caregivers
Deal Breakers
Must be a Registered Nurse (RN) to meet the RN Case Manager role requirements, Must comply with state and federal regulatory requirements and TJC accreditation standards
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