RN Case Manager
Advocates for patients and families and acts as a liaison with other team member to ensure that our patient’s healthcare needs are being addressed. Collaborates with physicians and assists in referring healthcare resources to ensure services and care are delivered in a timely manner. The RN Case Manager works in collaboration with patients, providers, and key individuals in coordinating a safe discharge.
Essential Job Duties:
- Assesses client needs upon intake to determine appropriate course of care. Serves as a liaison between the patient and their family and the patient's network of care providers.
- Educates patient on diagnosis, treatment options, and prognosis. Assists the patient in scheduling appointments, completing paperwork, or securing referrals.
- Tracks and reports on patient progress. Actively participates in multidisciplinary huddles daily.
- Performs work under minimal supervision. Handles complex issues and problems and refers only the most complex issues to higher-level staff.
- Provide thorough care planning and coordination of all nursing and therapy staff in patient care.
- Ensures implementation of and compliance with company policies and procedures.
- Analyzes medical records to determine legitimacy of admission, treatment, and length of stay in acute setting in accordance with patient needs, regulatory standards and insurance company guidelines.
- Works effectively with insurance companies including Medicare and Medicare Advantage plans, AHCCCS, and Commercial plans
- Assures that denials are quickly addressed and supporting clinical evidence is sent in a timely fashion.
- Coordinates Peer to Peer appeals between the WCH provider and the Insurance carrier.
- Participates in department meetings and assigned projects.
- Is a key member of the WCH clinical team, offering mentoring and expertise as appropriate.
- Current Arizona RN license
- Associates Degree in Nursing
- A minimum of 3 years of nursing experience.
- Demonstrated oral and written communication skills, problem-solving skills.
- An attention to detail and successful outcomes by stated deadlines is key.
- Must have a track record of working closely with physicians and interdisciplinary team members; exhibit a service orientation.
- Must have extensive background in working with insurance companies including Medicare and Medicare Advantage plans, AHCCCS, and Commercial plans
- Bachelor’s degree in nursing
- 4+ years of nursing experience, with at least 1 year of Case Management experience.
- Nursing/Certified Case Manager (CCM) is desired
Physical Requirements/Working Conditions:
- Frequent standing, stooping, bending, stretching, squatting; must be able to stand/walk for most of the work day.
- Must be able to work paying close attention to detail with frequent interruptions.
- Ability to work in a fast pace environment.