RN Case Manager

4 weeks ago


Springfield, Illinois, United States Effingham Health System Full time
Job Summary

Effingham Health System is seeking a skilled RN Case Manager to join our team. As a RN Case Manager, you will be responsible for managing a designated patient caseload and planning effectively to meet patient needs, manage the length of stay, and promote efficient utilization of resources.

The ideal candidate will have a solid knowledge base, critical thinking skills, and ability to apply evidence-based guidelines. Excellent interpersonal skills, self-motivation, and strong organizational skills are essential for success in this role.

Key Responsibilities
  • Admission review and continued stay reviews of patients using evidence-based clinical guidelines
  • Contacting insurance companies to provide clinicals to support admissions/continued hospital stays
  • Referring cases to the Physician Advisor for further review and collecting QA and Avoidable Days data as directed
  • Functioning as an integral member of a collaborative and interdisciplinary team to re-assess and adjust the plan for care progression and transition according to the patient's clinical condition
  • Providing federal notices to Medicare beneficiaries per federal guidelines and hospital policy
  • Supporting Nursing Services and other clinical and non-clinical ancillary services in assuring the continuum of care for patients and in maintaining the quality of service delivery
  • Serving as a patient advocate in appropriate utilization of benefits and community resources
  • Completing and documenting timely clinical reviews based on assessment of medical necessity and documented clinical findings in accordance with hospital policy and payer findings
  • Demonstrating understanding of medical necessity and intensity of service and incorporating payer requirements into development of safe, effective, and timely discharge plan
  • Incorporating risk of re-admission and socio-economic factors in the creation of a safe and individualized transition plan
  • Engaging patient and family support network in developing the transition plan
  • Collaborating with interdisciplinary team throughout the patient's stay to re-assess and adjust the plan for care progression and transition according to the patient's clinical condition
  • Maintaining communication with Transitional Care Director to review and discuss patient care, progress, and identified outcomes
  • Participating and facilitating patient care conferences and family meetings
  • Facilitating peer-to-peer discussions between attending physicians, case managers, physician advisors in cases requiring evaluation and justification of medical necessity for admission by payer
  • Assuring prompt reporting of medical/legal issues to Risk Management, supervisor, and appropriate Administrative parties
  • Developing and maintaining a good working rapport with other departments within the facility and outside community health & welfare and social agencies to assure that social service programs can be properly utilized to meet the needs of the patient
  • Within Scope of Nursing practice, the Case Manager continuously assesses self-knowledge and competencies to assure job performance
  • Ensuring adherence to proper infection control, OSHA, and safety standards

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and compassionate RN with a passion for case management, we encourage you to apply for this exciting opportunity.



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