Registered Nurse Case Manager Job Description
Registered nurse case manager
provides leadership to staff, management, physicians and others in implementation of and compliance with Medicare/Medicaid regulations/rules/guidelines and utilization rules of third party payer contracts.
Registered Nurse Case Manager Duties & Responsibilities
To write an effective registered nurse case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included registered nurse case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Facilitate a physician-specific plan of care, ensure appropriate resource utilization, and coordinate utilization review and approval by a payer
Demonstrate knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner
Knowledge of Interqual, utilization review, and discharge planning regulations (Preferred)
Collaborates with the business office, utilization review staff, denials management and physician advisors in order to communicate medical necessity/insurance information to the multidisciplinary team
Perform resource utilization review studies in collaboration with medical records and quality management staff
The Care Coordinator works in partnership with the patient and/or care partner(s) to develop a comprehensive, individualized transitional care plan
Determines the special needs of the resident
Facilitates resident placement based on clinical services needed, bed availability, resident/family preference, geographic location
Facilitate clinical patient progression through a defined plan of care to achieve optimal outcomes
Support or coordinates discharge planning services and act as an effective member of the interdisciplinary team in improving quality, services, and financial aspects of overall patient care management
Registered Nurse Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Registered Nurse Case Manager
List any licenses or certifications required by the position: CPR, BLS, CCM, AHA, CPHQ, ACM
Education for Registered Nurse Case Manager
Typically a job would require a certain level of education.
Employers hiring for the registered nurse case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Health Care, Management, Graduate, Science, Nursing Program, Education, School of Nursing, Associates, Health
Skills for Registered Nurse Case Manager
Desired skills for registered nurse case manager include:
Microsoft Office programs
Managed care
Medical terminology
Utilization review
CMS guidelines and experience working with payor specific guidelines and contractual rules
Current managed care contracts
Federal statutes
Payer contracts and provides clinical information to payers
Quality assessment and assurance procedures
Regulations and procedures
Desired experience for registered nurse case manager includes:
Complete all initial utilization reviews within 24 hours of inpatient admission
Conduct concurrent reviews as appropriate per payer requirements and the Utilization Management Plan
Evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the case load according to Case Management Department Plan, policies and procedures
Participate in discharge planning role by completing initial discharge planning assessments, formulating and implementing an appropriate discharge plan
Function in a team approach to coordinate appropriate and safe discharge planning from the newborn to the geriatric patient
Experience with PC applications required
Registered Nurse Case Manager Examples
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Registered Nurse Case Manager Job Description
Job Description Example
Our growing company is looking to fill the role of registered nurse case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for registered nurse case manager
- Facilitate interdisciplinary team care coordination, intensive medical management of participants recently discharged from hospital and skilled nursing facilities
- Collect the necessary medical and social information to ensure comprehensive decisions are made which ensure the safety and well being of participants
- Act as a medical advocate for the participant, and coordinate care services with the Interdisciplinary team
- Build strong relations with participants, caregivers, families and community providers so that communication and coordination occurs in a manner that facilitates optimal care and financial oversight
- Contribute to the development of a goal-directed, age-appropriate plan of care through an interdisciplinary team process that is prioritized and based on determined medical diagnosis, patient needs, and expected patient outcomes
- Collaborate daily with physicians and care team members to support the assessment of continued need for acute care hospitalization
- This position is a day-time, Monday through Friday, 40 hours/week position
- Identifies cultural, socio-economic, religious, and other factors that may impact treatment
- Other related case management review duties as directed
- Collaborates with the patient, family or other caregivers, and multidisciplinary team to design a discharge plan respective of the patient’s needs and goals
Qualifications for registered nurse case manager
- Three (3) years of recent clinical practice experience
- Minimum of two-three (2-3) years of case management experience
- Must be comfortable with hands on clinical duties Case Management
- 3 or more years of acute hospital, home health, hospice, and/or inpatient mental facility experience required
- Knowledge of the ICD-9/CPT codes
- Use of analytical tools to extract information from members/providers on needs and desires
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Registered Nurse Case Manager Job Description
Job Description Example
Our growing company is looking for a registered nurse case manager. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for registered nurse case manager
- Monitor risk assessment via LACE+ and implement discharge interventions accordingly
- Identify patients with an unplanned readmission and complete root cause analysis
- Collaborate with Outpatient Care Managers to identify patients for handover and post discharge follow up
- Assures compliance with regulatory and payer source requirements
- Actively addresses and monitors resource utilization and documents avoidable delays/days
- Arrange for post discharge needs as appropriate, including but not limited to, DME, HHC, transportation, prescriptions, and follow up appointments
- Uses electronic systems to accurately document care management functions
- Perform the primary functions of assessment, planning, facilitation and advocacy, which are achieved through collaboration with the client and other health care professionals involved in the client’s care
- Ensure timely discharge through early intervention and identification of post-hospital care needs
- Ensure continuity of care needs are assessed and met for both inpatient and outpatients as needed, based on the age of the patient
Qualifications for registered nurse case manager
- Bilingual Spanish or Chinese (Mandarin or Cantonese) required
- Graduate of an accredited school of nursing with an ADN or greater
- Must be a licensed Registered Nurse (RN) in the state of Indiana
- Extensive knowledge of procedures and protocols related to Discharge Planning
- ECIN and/or MIDAS experience preferred
- CCM a plus
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Registered Nurse Case Manager Job Description
Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of registered nurse case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for registered nurse case manager
- This position is accountable for leading, directing and overseeing a team of nurse case managers
- Provides coaching and clinical supervision
- Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family
- Provides clinical assessments, health education, and utilization management to members
- Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services
- Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members
- Tasks involve a degree of forward planning and anticipation of needs/issues
- Resolves non-routine issues escalated from more junior team members
- Services include comprehensive assessment, development of individualized services plans, care coordination and planning and ongoing support for Medicare and Medicaid members
- Collaboration and facilitation with other interdisciplinary care team members
Qualifications for registered nurse case manager
- A minimum of two years of RN experience
- RN with unrestricted, active license
- Transplant and /or critical care experience preferred
- Certified in Case Management preferred
- Compact RN License a plus
- California licensed RN residing in California a plus
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Registered Nurse Case Manager Job Description
Job Description Example
Our innovative and growing company is hiring for a registered nurse case manager. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for registered nurse case manager
- Meet established performance and compliance metrics
- Attends regular meetings with managers/staff to address issues and concerns
- Collaborate cross-functionally to meet goals and objectives to meet business goals and client expectations
- Ensure compliance with State and Federal regulations, contract requirements, URAC and NCQA standards and company policies and procedures
- Supports and facilitates hospital goals for capacity management and length of stay (LOS)
- Works with the multidisciplinary healthcare team to develop, activate and efficiently facilitate patient treatment and discharge plans
- Coordinates the integration of case management functions into the patient care, discharge planning processes in collaboration with the physician, other hospital departments, external service organizations, agencies and healthcare facilities
- Identification and tracking of avoidable internal, external and physician delays
- Meets with patients/families to discuss realistic and appropriate discharge options and providers to coordinate the discharge plan
- Demonstrates knowledge in admission and continued stay criteria for inpatient and observation in order to facilitate proper patient placement across the healthcare continuum
Qualifications for registered nurse case manager
- Minimum of an additional two years’ experience in healthcare related fields
- Minimum of three (3) years of RN experience, required
- Case Manager Certification (CMC), preferred
- At least one (1) year of hospital nursing experience, preferred
- Graduate of Nursing School or Social Worker - LCSW
- RN License and/or LCSW
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Registered Nurse Case Manager Job Description
Job Description Example
Our company is growing rapidly and is looking for a registered nurse case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for registered nurse case manager
- Demonstrates and encourages positive interpersonal relations with the patient/family, physicians, community agencies, and other members of the health care team
- Leads and/or participates in weekly unit interdisciplinary discharge meetings (ICPC) along with hospital LOS meetings for complex patients
- Documents clear/concise discharge assessments/plans in patient’s electronic medical record via Cerner Care Manager
- Maintains computer proficiency to perform/complete work assignments including the electronic medical record, Care Manager, and Outlook e-mail/calendar management
- Exhibits organizational skills, flexibility, and teamwork
- Provides necessary coverage and assistance with other duties within the department when needed
- Active Florida State License as a Registered Nurse or LPN
- Minimum 2 years recent acute care experience
- Minimum of an additional 2 years of experience in healthcare related fields
- Proficiency in the daily use of standard office equipment such as computer, phone, fax, copier, and sill in utilizing Microsoft Work and Outlook tools
Qualifications for registered nurse case manager
- Previous hospital setting preferred
- BSN with active, unrestricted Texas license residing in the El Paso, TX area
- Bi-lingual English and Spanish speaking required
- The role is telecommute, but will be expected to attend meetings at El Paso Health Plan office and will travel to members in El Paso as needed to attend in-person assessments
- Case Management certification highly desirable ACM (Accredited Case Manager
- FL RN Licensure, or Recognized Compact Licensure (subject to Florida State Licensing Requirements, including/not limited to ongoing eligibility and duration provisions)