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Manager of RN Case Management Services
6 days ago
Dallas, Texas, United States NCH Healthcare Full timeDEPARTMENT: NCH Case Management ABOUT NCH NCH is a locally governed, independent non-profit healthcare organization situated in Southwest Florida, comprising two hospitals and a network of over 700 physicians along with numerous medical facilities. NCH is dedicated to delivering exceptional comprehensive healthcare and is evolving into an Advanced Community...
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RN Case Manager, Inpatient
3 months ago
Boston, MA, United States Boston Children's Hospital Full time74825BRPatient Services-Patient Care OperationsJob Posting DescriptionThe Per Diem RN Case Manager (inpatient and/or ambulatory) will be responsible for:Assessing, planning, organizing and overseeing daily clinical operations of care coordination and transitions to address the comprehensive and complex health needs of the patient and family.Possessing...
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Corpus Christi, TX, United States UnitedHealth Group Inc Full timeRegistered Nurse Inpatient Case Manager Healthcare Corpus Christi TexasOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and...
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Case Manager RN Inpatient Rehab
3 months ago
Asheville, NC, United States CarePartners Full timeDescription IntroductionCarePartners is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Case Manager RN Inpatient Rehab position and spend more time at the bedside with the patient.BenefitsCarePartners, offers a total rewards...
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Case Manager RN Inpatient Rehab
1 week ago
Asheville, NC, United States CarePartners Full timeDescription Introduction CarePartners is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Case Manager RN Inpatient Rehab position and spend more time at the bedside with the patient. Benefits CarePartners, offers a total rewards...
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Case Manager RN Inpatient Rehab
1 month ago
Asheville, NC, United States CarePartners Full timeDescription IntroductionCarePartners is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Case Manager RN Inpatient Rehab position and spend more time at the bedside with the patient.BenefitsCarePartners, offers a total rewards...
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Case Management
1 month ago
Wilmington, DE, United States Nemours Foundation Full timeCase Management - RNThe Nurse Case Manager (NCM) is responsible for the coordination of care of individual patients in the Inpatient acute care environment at Nemours and those discharging from other community hospitals. Through the use of the nursing process, the patient care will be assessed, planned, implemented and evaluated with consideration to the...
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Case Management
3 weeks ago
Wilmington, DE, United States Nemours Foundation Full timeCase Management - RNThe Nurse Case Manager (NCM) is responsible for the coordination of care of individual patients in the Inpatient acute care environment at Nemours and those discharging from other community hospitals. Through the use of the nursing process, the patient care will be assessed, planned, implemented and evaluated with consideration to the...
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Inpatient Psychiatric Case Manager
3 weeks ago
Vineburg, CA, United States Kaiser Full timeJob Summary: Provides inpatient and intensive outpatient case management for high-risk, high-utilizing members with acute and/or chronic psychiatric conditions across the continuum of care. Develops treatment and care plans for the specific population. Essential Responsibilities: * Plans, develops, coordinates, assesses, and evaluates services provided to...
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RN-Inpatient Case Manager
4 days ago
Albuquerque, NM, United States Presbyterian Healthcare Services Full timeOverview:Type of Opportunity: Part TimeFTE: 0.650000Exempt: YesWork Schedule: DaysSign-on Bonus & relocation available for qualified candidates. Schedule a call with the recruiter to learn more.We're all about well-being, starting with yours.Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and...
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RN - Inpatient Case Manager
6 days ago
Albuquerque, NM, United States Presbyterian Healthcare Services Full timeOverview:Type of Opportunity: Full TimeFTE: 1.000000Exempt: YesWork Schedule: DaysSign-on Bonus & relocation available for qualified candidates. Schedule a call with the recruiter to learn more.[Sign on and relocation bonuses available for qualified candidates.]We're all about well-being, starting with yours.Presbyterian employees have access to a fun,...
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Pool Case Manager RN
1 month ago
Tampa, FL, United States Tampa General Hospital Full timePool Case Manager RN - InpatientJob Description: The Case Manager is responsible for ensuring patient progress and meeting and facilitating a safe and sustainable transition plan. Collaborates with Physician and Interdisciplinary Team to determine plan of care, treatment, estimated LOS, and likely discharge disposition (home, LTAC, SNF, or ALF). Ensures...
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Sinton, TX, United States Optum Full timeOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you...
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Manager of Case Management RN
1 week ago
El Paso, TX, United States Las Palmas Medical Center Full timeDescription IntroductionWant to join a team of daring managers who care without reservations or limits? Our Las Palmas Medical Center team is looking for a(an) Manager of Case Management RN. HCA Healthcare is an advanced healthcare network that has committed up to $300 million to our incredible team members over the course of three years.BenefitsLas Palmas...
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Manager of Case Management RN
3 days ago
El Paso, TX, United States Las Palmas Medical Center Full timeDescription IntroductionWant to join a team of daring managers who care without reservations or limits? Our Las Palmas Medical Center team is looking for a(an) Manager of Case Management RN. HCA Healthcare is an advanced healthcare network that has committed up to $300 million to our incredible team members over the course of three years.BenefitsLas Palmas...
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Case Management
3 months ago
Wilmington, DE, United States Nemours Full timeThe Nurse Case Manager (NCM) is responsible for the coordination of care of individual patients in the Inpatient acute care environment at Nemours and those discharging from other community hospitals. Through the use of the nursing process, the patient care will be assessed, planned, implemented and evaluated with consideration to the appropriate use of...
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Case Manager-RN
2 months ago
Redlands, CA, United States Loma Linda University Full timeJob Summary: The RN-Case Manager is responsible for utilization management and inpatient care management in a telephonic and/or onsite care management position; performs reviews of inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination; focuses on changing from...
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Case Manager-RN
2 months ago
Redlands, CA, United States Loma Linda University Full timeJob Summary: The RN-Case Manager is responsible for utilization management and inpatient care management in a telephonic and/or onsite care management position; performs reviews of inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination; focuses on changing from...
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Corpus Christi, TX, United States UnitedHealth Group Inc Full timeRegistered Nurse Inpatient Case Manager Healthcare Corpus Christi Texas Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and...
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Decatur, GA, United States Kaiser Permanente Full timeJob SummaryResponsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when...
RN Case Manager, Inpatient Services
2 months ago
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The RN Case Manager II - Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Actively implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The case manager is responsible for coordinating the care from admission through discharge. The Case Manager participates in Patient Care Conferences to review clinical status, update/finalize transition discharge needs, and identify members at risk for readmission. If you are located in Dallas, TX, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: * Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for members * Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation system * Performs expedited, standard, concurrent, and retrospective onsite or telephonic clinical reviews at in network and/or out of network facilities. The Case Manager documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines for all authorizations * Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information * Identifies member's level of risk by utilizing the Population Stratification tools and communicates during transition process the member's transition discharge plan with the ICT * Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care * Manages assigned case load in an efficient and effective manner utilizing time management skills * Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities * Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddles * Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better on a monthly basis * Adheres to organizational and departmental policies and procedures * Takes on-call assignment as directed * Maintain current licensure to work in State of employment and maintain hospital credentialing as indicated * Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines * Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms * Refers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situations * Monitors for any quality concerns regarding member care and reports as per policy and procedure * Performs all other related duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Bachelor's degree in Nursing and/or, Associate's degree in Nursing combined with 4+ years of experience above the required years of experience * Current, unrestricted RN license required, specific to the state of employment * Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment * 4+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions * Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel * Proven ability to read, analyze and interpret information in medical records, and health plan documents * Reliable transportation that will enable you to travel to client and/or patient sites within a designated area Preferred Qualifications: * 3+ years of managed care and/ or case management experience * Experience working with psychiatric and geriatric patient populations * Knowledge of utilization management, quality improvement, and discharge planning * Proven ability to problem solve and identify community resources * Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously * Proven planning, organizing, conflict resolution, negotiating and interpersonal skills * Proven ability to utilize critical thinking skills, nursing judgement, and decision making skills * Bilingual (English/Spanish) language proficiency Physical & Mental Requirements: * Ability to lift up to 25 pounds * Ability to push or pull heavy objects using up to 10 pounds of force * Ability to sit for extended periods of time * Ability to stand for extended periods of time * Ability to use fine motor skills to operate office equipment and/or machinery * Ability to receive and comprehend instructions verbally and/or in writing * Ability to use logical reasoning for simple and complex problem solving * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
