Registered Nurse, Case Manager

Monitors and manages patient care to promote continuity of care, optimal outcomes, patient satisfaction, cost efficiency, and regulatory compliance. Collaborates with the multidisciplinary team, payors, and community resources; leads discharge planning and utilization review activities. Reports to the Director or Manager of Department.

• Consults regularly with nursing staff and the multidisciplinary team to evaluate patient status and appropriateness of care, including admission, length of stay, transfers, and discharge.
• Monitors patient and family satisfaction; responds to questions and complaints from patients, families, and payors.
• Leads and coordinates discharge planning, including patient transfers to other facilities and referrals to community resources; provides discharge education.
• Performs chart reviews to identify and address issues related to service delivery, patient outcomes and satisfaction, compliance, cost, and reimbursement.
• Communicates effectively with providers, payors, and ancillary services to remove barriers and ensure timely care progression.
• Accurately documents case management activities, plans, and outcomes.
• Participates in performance improvement and required continuing education.
• Supports department operations by working alternate shifts/units as needed; may be assigned on-call.
• Performs other duties as assigned.

Patient Populations Served: Neonate, Infant, Early Childhood, Late Childhood, Adolescent, Young Adult, Middle Adult, Older Adult. Protected Health Information Accessed: Demographic, Clinical, Insurance, Financial, Complete Medical Record. Exposure: Occupational exposure to bloodborne pathogens may be present. Physical Requirements (typical): Frequent keyboard data entry, sitting, standing, walking, and repetitive hand/arm movements; occasional kneeling, squatting, pushing/pulling and lifting/carrying up to 25 lbs; rare climbing or running. Vision demands include near/far vision and depth perception (constant); color distinction frequent; smell and taste rarely required.

Education: Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred. License/Certifications: Current RN license in state of practice; BCLS required. Skills: Critical thinking and decisive judgment; ability to work with minimal supervision in stressful environments. Proficiency learning/navigating multiple clinical software systems. Effective English communication (read, write, speak, and understand). Ability to complete the Skills Competency Checklist within 90 days of hire.