About the role
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Job Summary
The RN Case Manager plays a critical role in optimizing patient care and resource utilization. The incumbent is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs. This role focuses on quality patient outcomes and cost-effective healthcare delivery and may encompass general medical case management or specialize in high-acuity areas and/or high-cost areas such as high-risk obstetrics and neonatal care, chronic disease management, and/or mental health support (excludes Behavioral Health).Requirements
EDUCATION
Bachelor's degree in Nursing preferred.
LICENSING/CERTIFICATION
Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.
Case management certification required. If certification is not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager. The acceptable case management certifications are Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse - Board Certified (RN-BC).
KNOWLEDGE & EXPERIENCE
Minimum four (4) years' clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
ESSENTIAL ABILITIES & SKILLS
Independence
Detail oriented
Skills
• Administrative Process• Affinite CM• Affinite UM• CCI Edits• Collaborative Communications• Critical Reasoning• Cross-Functional Planning• Customer Relationship Management (CRM)• Customer Service Workstation• Deductive Reasoning• Five9• Information Security• Interpersonal Relationship Management• Microsoft Excel• Microsoft Office• Microsoft Outlook• Microsoft PowerPoint• Needs Assessment• Oral Communications• Problem Sensitivity• Researching• Sound Judgment• Support Coordination• Written CommunicationResponsibilities