RN Case Manager
Core
Acts as a patient advocate and Case Manager to coordinate, negotiate, and procure services for complex patients to facilitate quality and cost-efficient outcomes.
Role type
Senior Registered Nurse Case Manager
Builds
Safe and timely discharge plans and care coordination across the continuum of care
Domain
Healthcare / Case Management / Utilization Review
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization review, discharge planning, care coordination, medical necessity determination, interdisciplinary collaboration, insurance coverage management, patient advocacy
Preferred skills
Knowledge of InterQual criteria, experience with Medicare/Medicaid regulations, ability to work weekends and holidays
Technologies
EHR, InterQual, eDischarge, MCCM
Responsibilities
Review medical records to determine medical necessity for admission and continued stays; coordinate discharge planning and identify barriers to timely discharge; consult with physicians and nursing staff to determine appropriate patient status (observation vs. inpatient); process referrals to continuum of care providers; manage insurance coverage termination and reinstatement; facilitate patient and family awareness of care options and portals.
Seniority
Senior, hands-on IC