Case Manager
Core
RN Case Manager acting as a patient advocate to coordinate, negotiate, and procure services for complex patients to facilitate quality and cost-efficient outcomes.
Role type
Registered Nurse Case Manager
Builds
Safe and timely discharge plans and care coordination for inpatient and observation patients
Domain
Healthcare / Hospital Case Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical necessity review, discharge planning, care coordination, insurance coverage verification, interdisciplinary collaboration, resource utilization analysis, regulatory compliance, clinical data management
Preferred skills
Case management certification, InterQual certification, Lean principles knowledge, ACO relationship management
Technologies
eDischarge, EHR, Interqual, MCCM, Epic, Workday
Responsibilities
Review medical records to determine medical necessity for admission and continued stays; coordinate discharge planning and referrals to sub-acute settings; manage insurance coverage and reimbursement processes; collaborate with physicians and nursing staff on patient status; participate in quality improvement initiatives
Seniority
Mid-level, hands-on IC