RN, Care Manager Job Description

RN, Care Manager Job Description

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RN, care manager provides ongoing education and support to clinicians regarding documentation, case management, resource utilization and quality clinical practice.

RN, Care Manager Duties & Responsibilities

To write an effective RN, care manager job description, begin by listing detailed duties, responsibilities and expectations. We have included RN, care manager job description templates that you can modify and use.

Sample responsibilities for this position include:

Handle Utilization Management and use prescribed criteria to provide timely, appropriate, and medically necessary service authorizations
Utilization Management and using prescribed criteria to provide timely appropriate and medically necessary service authorizations
Reviewing clinical outcomes to determine appropriateness of care and ensure Company and contract obligations are met
Reviewing medical treatments and approving or denying care based on medical and contract guidelines
Consulting with Medical Director on unusual cases to determine appropriate services
Reviewing non-standard service outcomes and entering outcomes into the Authorization Tracking System ensuring entry of all required information
Reviewing data entered into ATS by Customer Service Agents to ensure accuracy and completeness
Calling patients to discuss care, clarify, augment and/or confirm accuracy of information received from providers to ensure appropriate care as necessary
Ensuring providers are informed of patient needs, treatment modification, and/or progress when necessary or requested
Handling complex clinical issues or questions and troubleshooting clinical problems

RN, Care Manager Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for RN, Care Manager

List any licenses or certifications required by the position: CCM, ABQAURP, ACM, BLS, PALS, HCP, PRI, ACLS, BCLS, CPR

Education for RN, Care Manager

Typically a job would require a certain level of education.

Employers hiring for the RN, care manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Science, Graduate, School of Nursing, Healthcare, Nursing Program, Social Work, Management, Social Sciences

Skills for RN, Care Manager

Desired skills for RN, care manager include:

Community resources
Utilization management
Local
Evidence-based clinical practice
Payer industry
Reimbursement
Resource management
Case management and healthcare provided throughout the continuum
Managed care principles
Physical and psychological characteristics of disease processes

Desired experience for RN, care manager includes:

Utilizing knowledge of ATS, contract obligations, infertility, and best business practices to provide superior service to clients
Organize Interdisciplinary Care Team (ICDT) meetings and act as facilitator to ensure that members’ needs are met
Develop an ICP/PCSP based on members’ clinical, behavioral and social needs that incorporates barriers to care
Modify ICP/PCSP as appropriate to member’s needs and progress
Prepare for and participate in clinical case reviews to share best practices
Adhere to the organization's documentation policies and procedures including documentation of Care Management activities and their effectiveness

RN, Care Manager Examples

1

RN, Care Manager Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of RN, care 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 RN, care manager
  • Identify strengths/barriers related to health related conditions and provide feedback to medical/behavioral staff and case planners assigned to the foster care unit
  • Perform regular assessment of client's needs and progress to avoid unnecessary, inappropriate utilization of emergency room and inpatient hospital services
  • Visit client's when hospitalized and obtain discharge paper work and after care plan
  • Demonstrate a capacity to use health information technology
  • Coordinate appointments and scheduling, including acute and annual visits are managed and kept
  • Complete home visits as necessary to meet foster care guidelines around health needs
  • Handle medical emergencies
  • Review interdisciplinary plan of care and assess the patient's needs
  • Ensure that the interdisciplinary care plan, discharge plan and care are consistent with the patient's clinical course, continuing care needs and covered services
  • Analyze patient record to determine that the medical record documentation reflects the medical necessity of hospitalization and the services rendered are necessary and appropriate
Qualifications for RN, care manager
  • Document clinical reviews according to departmental standards
  • Assess short-term and long-term needs and establish case management objectives
  • Manage 75 to 100 active cases based on case intensity and acuity
  • Interact continuously with member, family, Physician(s), IDT members, and other providers to utilize clinical knowledge and expertise to determine medical history and current status
  • Managing 75 to 100 active cases based on case intensity and acuity
  • Maintaining accurate records of care management activities in the EMMA system using clinical guidelines
2

RN, Care Manager Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of RN, care 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 RN, care manager
  • Present findings of the health risk assessment and the member’s priority issues clearly and efficiently to an Interdisciplinary Team, including Physicians
  • Develop potential interventions to address areas of risk to discuss with the member and their Interdisciplinary team (IDT)
  • Facilitate IDT meetings, which includes setting an agenda with the member, prioritizing areas that need to be discussed and documenting approved services and agreed to interventions
  • Additional licensures may be required in multiple states based on business needs
  • Contributing to the development of patient-focused care and initiating the process in accordance with established guidelines
  • Assessing member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff
  • Assisting in identifying opportunities for and facilitating alternative care options based on member needs and assessments
  • Evaluating and pre-authorizing request for inpatient / outpatient, specialty care, home care, Durable Medical Equipment, and transportation services from network and out-of-network providers in accordance with departmental guidelines
  • Documenting all interventions and telephone encounters with providers, members, and vendors in the appropriate system to ensure integrity of member services provided over the continuum of care and over time
  • Negotiating, procuring and coordinating services and resources needed by the patient and family
Qualifications for RN, care manager
  • 2+ years of home care or case management experience
  • Management experience with RNs
  • 1+ year of Care / Case Management experience
  • Past care management and UAS experience
  • Required 1+ year of experience in current case or disease management experience
  • Associate's degree from an accredited school of Nursing required
3

RN, Care Manager Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of RN, care manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for RN, care manager
  • Ensures compliance with JCAHO, Federal and State requirements and professional standards for case management, utilization management, discharge planning/continuum of care through policy and procedure development, implementation, and monitoring
  • RESOURCE MANAGEMENT – Demonstrates stewardship of financial, material, and human resources
  • Assists in monitoring appropriate hospitalization and continued stays
  • Attends and participates in department meetings and participates in multidisciplinary groups as necessary and/or requested
  • Bachelor degree in nursing required within 5 years after date of hire
  • Utilization review experience required
  • Identify client care needs by establishing comprehensive assessment of the health needs of children in care through direct means of interaction
  • Develop a comprehensive coordinated care plan based on that assessment in conjunction with the medical home staff and treatment team
  • Establish for children in care a medical home that will address current and future health care needs
  • Act as a liaison between multiple providers in the provision of health services for our children in care
Qualifications for RN, care manager
  • RN, three years of direct patient care experience in an acute care hospital in a leadership role preferred
  • Experience working with diverse populations with language, cultural, and socioeconomic differences required
  • Experience working with uninsured and underinsured patient populations preferred
  • Demonstrated competency in Microsoft Office Suite™ required
  • BLS through the American Heart Association with card in-hand before start date, and current AHA BLS must be good through sixty days of hire
  • Must hold a current, valid Arizona or compact state RN license
4

RN, Care Manager Job Description

Job Description Example
Our innovative and growing company is looking for a RN, care 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 RN, care manager
  • Understands the value of teamwork and interdependency of various hospital disciplines, and establishes and maintains appropriate relationships across professional disciplines
  • Fosters an exceptional teamwork environment with nursing teams and interdisciplinary colleagues
  • Welcomes constructive ideas and problem-solving by direct reports
  • Demonstrates knowledge of and role models the organizations Core Values in performance of duties and communication with patients, families, staff and all disciplines
  • Develops and implements systems for compliance with government programs and other regulatory agencies
  • Monitors reports, unusual incidents, patterns, and processes within the Care Management Department, and recommends changes and improvements
  • DECISION MAKING – Demonstrates the ability to find information necessary to make solid clinical and business decisions
  • MANAGEMENT OF HUMAN RESOURCES – Recruits, orients, coaches, develops, supervises, and evaluates direct reports
  • COMMUNICATION – Demonstrates positive communication skills in establishing and fostering professional working relationships
  • INSTITUTIONAL AND/OR PROFESSIONAL STANDARDS – Supports the mission, philosophy, standards, goals and objectives of NYU Hospitals Center and Care Management program
Qualifications for RN, care manager
  • Graduation from an accredited school of nursing plusthree years of recent clinical work experience in the specialty area orrelated clinical specialty in a hospital setting within the past five years that demonstrates attainment of the requisite job knowledge skills/abilities
  • Bachelor's degree from an accredited school of Nursion preferred
  • 1 to 3 years experience as an RN in an acute care setting required, very broad base of nursing experience preferred
  • RN license in PA, WV, and DE is required
  • 1 to 3 years experience required (broad based / varied hospital RN experience)
  • Master’s degree and related clinical/case management experience
5

RN, Care Manager Job Description

Job Description Example
Our company is growing rapidly and is looking for a RN, care manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for RN, care manager
  • Administer on-going clinical care for each patient and provide necessary follow up
  • Complete physical assessments and monitoring of vital signs during house visits and report all concerning health changes to the Physician and Care team
  • Establish and maintain professional working relationship with health care providers and other members of the disciplinary teams in providing patient and family care
  • Monitor well-being of patients to ensure the delivery of dependable, high quality care
  • Dispense medication and provide medication pours
  • Document patient care in a timely manner and in accordance with agency, State and Federal guidelines
  • Complete required fieldwork (visits, in-house assessments, hospitalization discharge)
  • Assist in the development of initiative-related clinical and administrative policies and procedure, workflows, electronic health record template development, and internal and external referral process
  • Conduct outreach in venues or neighborhoods where there is unmet need for buprenorphine treatment and identifying individuals who may benefit from buprenorphine treatment
  • Screen and assess patients including obtaining patient demographic information and consents
Qualifications for RN, care manager
  • Required Other Illinois's Children with High Needs program requires a bachelor's degree in nursing, social sciences, social work or related field
  • Acute/Chronic case management or disease management experience preferred
  • Benefits Management/Maximizing Healthcare Quality/1+ years
  • Benefits Management/Supporting Medical Practice/1+ years
  • Benefits Management/Understanding Clinical Impacts/1+ years
  • Finance/Managing Aetnas Risk/1+ years

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