The RN Case Manager is responsible for coordinating and managing the clinical and psychosocial needs of a defined patient population across the continuum of care. This role collaborates with an interdisciplinary team to ensure high-quality, cost-effective outcomes, with a strong focus on assessments, care planning, patient advocacy, and transitions of care.
Responsibilities
* Perform comprehensive nursing assessments, including PCA and Level 2 assessments, to determine patient needs, eligibility, and appropriate levels of care.
* Develop, implement, and regularly update individualized care plans based on clinical findings, patient goals, and regulatory requirements.
* Coordinate services across inpatient, outpatient, home, and community settings to ensure safe and timely transitions of care.
* Monitor patient progress through regular follow-up, review of clinical documentation, and collaboration with providers, therapists, and ancillary services.
* Educate patients and families on diagnoses, medications, treatment options, and available community resources.
* Identify barriers to care, address social determinants of health, and escalate high-risk or complex cases when appropriate.
* Document assessments, care plans, interventions, and outcomes accurately and promptly in the EMR and required case management systems.
* Participate in interdisciplinary case conferences, utilization review, and quality improvement initiatives.
* Ensure compliance with federal, state, and payer regulations, as well as organizational policies and clinical standards.
Qualifications
* Current, unrestricted Registered Nurse (RN) license in the applicable state.
* Clinical experience in case management, care coordination, home health, acute care, managed care, or related settings.
* Ability to perform PCA and Level 2 assessments in accordance with state and payer guidelines.
* Knowledge of care transitions, utilization management, and community-based resources.
* Experience working with EMR systems and standard productivity or telehealth tools.
* Case Management certification (CCM, ACM, or equivalent) preferred but not required.
