RN Case Manager per-diem
Core
RN Case Manager acting as a patient advocate to coordinate, negotiate, and manage care for complex patients to facilitate quality and cost-efficient outcomes.
Role type
RN Case Manager
Builds
Care coordination and discharge plans for complex patients
Domain
Healthcare / Case Management
Required skills
Clinical assessment, discharge planning, care coordination, utilization review, insurance coverage verification, interdisciplinary collaboration, regulatory compliance
Preferred skills
Experience with InterQual criteria, Medicare/Medicaid guidelines, EHR systems
Technologies
InterQual, eDischarge, EHR, MCCM
Responsibilities
Review medical records to determine medical necessity for admission and continued stays; Identify cases failing criteria and refer for secondary review; Contact physicians to clarify documentation and notify of non-coverage decisions; Coordinate discharge planning and arrange referrals to sub-acute settings; Monitor observation status to prevent delayed discharges; Process referrals and track acceptances by care providers.
Seniority
Individual Contributor