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Clinical Case Manager RN

1 month ago

Grand Junction, Colorado, United States CodeForce Full time
Job Summary:

As a Clinical Case Manager RN, you will play a critical role in ensuring the efficient and effective delivery of healthcare services to our patients. You will be responsible for maintaining and improving the case management system, working closely with patients, physicians, and other healthcare providers to meet designated clinical, operational, and financial outcomes for patient populations.

Key Responsibilities:
  • Maintain and improve the case management system using ongoing interaction with patients, physicians, and other healthcare providers.
  • Assist physicians, patients, families, staff, and payers in providing care for patient populations that is appropriate, effective, and cost-efficient.
  • Coordinate clinical review requests from payer sources to ensure timely reviews and ultimately timely payments to the hospital.
  • Attend and actively participate in all departmental and interdepartmental meetings relative to Case Management/Social Services/Discharge Planning functions.

Requirements:
  • Bachelor's Degree in nursing with at least three (3) years of clinical experience in a hospital setting.
  • At least three (3) years of case management experience in a hospital setting.
  • At least two (2) years of Utilization Review experience with knowledge of evidence-based criteria guidelines.
  • Current unrestricted Registered Nurse license in the State of Colorado.
  • Case management certification (preferred) or will obtain within 1 year of employment.

Work Schedule:
Full-Time

Specialty Type:
Nursing

Sub Specialties:
Utilization Review RN