RN Case Manager Job Description
RN case manager
provides hospital case management/utilization review and discharge planning to assure that the patient progresses through the continuum of care and is discharged to the appropriate level of care.
RN Case Manager Duties & Responsibilities
To write an effective RN case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included RN case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Coordinate the care of an assigned patient population during the acute care phase of illness from a utilization and discharge planning perspective
Facilitation of discharge planning by interfacing with IDT members
Collaborate with providers to assess member's needs for early identification of and proactive planning for discharge planning
Facilitate accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards
Facilitate discharge planning by interfacing with IDT members
Assist with discharge planning and provide follow up
Medication reconciliation in supporting patient medication management, particularly as it relates to the post-discharge planning process in support of medication compliance, and treatment adherence
Communicating with physicians and clinical nursing staff regarding ongoing patient care
Interfacing with insurance carriers and billing departments to initiate appeals and obtain authorizations for treatment
Telephonic case management for a managed Medicaid plan
RN Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for RN Case Manager
List any licenses or certifications required by the position: CPR, BLS, PRI, CCM, AHA, CM
Education for RN Case Manager
Typically a job would require a certain level of education.
Employers hiring for the RN 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, Education, Graduate, School of Nursing, Management, Health, Science, Associates, Healthcare, Interdisciplinary
Skills for RN Case Manager
Desired skills for RN case manager include:
Utilization management
Discharge planning
Coding and DRG assignment process
Quality improvement
Utilization Review
Levels of care
Observation status
Acute care regulatory/accreditation requirements
Cost management
Regulatory requirements
Desired experience for RN case manager includes:
Disease education
Acting as a liaison between patients, their families and healthcare providers
Working with new admissions to assess their conditions and needs
Evaluating and updating plans of care
Function within the Patient Centered Care Model
Assess, plan, implement and evaluate care for a group of patients
RN Case Manager Examples
1
RN Case Manager Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of RN case manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for RN case manager
- Compliance with state and federal regulatory requirements, The Joint Commission (TJC) accreditation standards, and the Health Insurance Portability and Accountability Act (HIPAA)
- Support and coordinate the activities of the Social Workers within unit
- Participate in patient and benefit monitoring
- Operate under the direction and supervision of the Manager of Case Management and Medical Director
- Assist Primary Care Physician with ensuring the patient's ambulatory medical needs are met
- Conduct post-discharge calls
- Conduct follow-ups
- Make phone calls with patients
- Overseeing the nurses in the office
- Dealing with their members issues (medical issues, home health aid issues, medical supplies)
Qualifications for RN case manager
- Proficiency with the use of Mobile technology (Smartphone, wireless laptop)
- MLTC and UAS experience
- Certified Home Health Agency experience
- Complete PRIs
- Manage concurrent/retrospective clinical reviews for health plans
- Identify and escalate complex discharge issues
2
RN Case Manager Job Description
Job Description Example
Our company is looking to fill the role of RN case manager. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for RN case manager
- Providing ongoing education to the Physicians and Nurses (RNs) about levels of care
- Establish and implement the plan of care
- Review and revise the plan of care as necessary at least every 60 days
- Specify assignments for Home Health Aides
- Utilizing the criteria to confirm medical appropriateness for the admission and continued stay
- Assuring high quality, cost efficient medical outcomes for patients identified as having the need for inpatient hospital or observation services
- Evaluate and assess patients medical condition as ordered and report any significant change in condition immediately to physician for medical intervention and follow-up
- Regularly re-evaluating patient/client needs
- Arrange for counseling the patient and family in meeting related needs
- Participate in the process of assessment, planning, facilitating, monitoring, and evaluation of options and services to meet an individual patients health care needs
Qualifications for RN case manager
- Ensure that optimal healthcare services are readily accessible to patients
- Participate in the promotion of quality outcomes, patient satisfaction, and cost-effective care delivery
- Ensuring cost containment
- Continuity of medical services
- Assisting members and their families with resources and support
- Facilitate Interdisciplinary Team (IDT) activities and communication
3
RN Case Manager Job Description
Job Description Example
Our company is looking to fill the role of RN 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 RN case manager
- Notification of Re-Insurance cases to the Reinsurance Administrator
- Interpretation of Summary Plan Description and Benefits associated with each individual Plan
- Completing client reports as directed
- Promoting wellness in accordance with the Population Health Management model by directing members to PCP and educating members regarding health and wellness measures
- Collaborating with the Multidisciplinary Team to validate the care treatment plan
- Monitoring and updating the effectiveness of care treatment plan as the patients needs change
- Coordinating patient’s plan of care through case management of services and reporting significant changes
- Completing all documentation in accordance with the policies and procedures
- Providing and documenting the authorization and reauthorization for services
- Oversee patient and benefit monitoring
Qualifications for RN case manager
- Assess, plan, coordinate, implement, monitor and evaluate the care of each beneficiary under case management
- Perform all contractually required duties in a timely manner and document in MSR
- Document all interventions and outcomes for beneficiaries who receive case management
- Must be licensed as a Registered Professional Nurse in the state of practice
- Must have proof of comprehensive auto insurance coverage
- Participates in data collection and inputting (e.g., Avoidable Days, Readmissions, Important Message letter delivery, Condition Code 44)
4
RN Case Manager Job Description
Job Description Example
Our growing company is looking to fill the role of RN 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 RN case manager
- Participate in interdisciplinary discharge planning rounds so that the patient can be transitioned to the next level of care once medically stable
- Handling any medical emergencies, if needed
- Accompanying patients to any appointments that they might need
- Check eligibility, details of request, verify services in place against request, document in care radius
- Conduct member assessments
- Approve authorization or send case for MD Review
- Document all steps in CR individually
- Ensure process is completed within 14 day TAT from request receive date
- Interact with providers when necessary
- Conduct MLTSS eligibility surveys when necessary
Qualifications for RN case manager
- Must be a Registrered Nurse from an accredited school of nursing and be licensed to practice professional nursing in the State of Ohio
- Experience in acute care setting, or Case Management is strongly preferred
- 4 year Bachelors/Master’s degree preferred
- 1-3 years RN experience in acute care hospital
- 1-3 year’s Case Manager experience in acute care setting and/or Managed Care Preferred
- Must have a minimum of 1-year general nursing experience with current Hospice, medical, surgical or critical care experience
5
RN Case Manager Job Description
Job Description Example
Our company is growing rapidly and is hiring for a RN 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 RN case manager
- Coordinates utilization review activities with focus on admission, concurrent/continued stay and retrospective review for the purpose of acute care certification
- Educates the interdisciplinary team on the process of utilization review/case management
- Serves as a resource to social work/treatment team related to discharge planning
- Creates and manages electronic patient files to document patient data including treatments and progress
- Interact with physicians and other department staff
- Educate families
- Interact with Appeals and Quality Management departments
- Work with insurance companies and payers
- Interview patients, families, and physicians
- Communicating with the Physician regarding patient's needs and reporting any changes in the patient's condition
Qualifications for RN case manager
- Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required
- Three (3) years clinical practice experience
- 3+ years’ experience with advanced coding, including the most complex
- Must possess a minimum of three years experience in MR/DD or related field
- Requires the ability to manage multiple tasks and to research and provide guidance on laws, regulations and nursing practice for state of operation
- 1 - 3 years of Case Management experience is strongly preferred