RN Case Manager

1 month ago


Waukegan, Illinois, United States Vista Health System Full time
Job Summary

We are seeking a skilled RN Case Manager to join our team at Vista Health System. As a key member of our healthcare team, you will play a vital role in ensuring the seamless transition of patients through the care continuum.

Key Responsibilities
  • Collaborate with the healthcare team to assess, plan, implement, monitor, and evaluate options and services to enable patient progression through the care continuum.
  • Develop and implement timely case management plans in collaboration with the multidisciplinary team to ensure efficient and effective care.
  • Conduct admission reviews and continued stay reviews to ensure the appropriateness of the setting and communicate with physicians as necessary.
  • Coordinate discharge planning, including referrals for home health, hospice, DME, and community services, to facilitate patient movement to the appropriate level of care.
  • Provide education to patients, physicians, and the community on discharge level of care, referrals, and transition to the continuum.
  • Perform utilization review duties, including conducting admission reviews and continued stay reviews, and coordinating with third-party payers to ensure precertification and recertification as required.
  • Support the Patient Health Information Project (PHIP) by communicating with assigned coders and prompting physicians as necessary to provide requested documentation.
  • Maintain accurate and timely documentation of all review data, including utilization information and contacts with payers.
  • Provide information regarding denials and approvals to the appropriate liaison and work with third-party payers to develop a case for overturning denials for reimbursement.
Requirements
  • Current RN licensure and a minimum of 2 years of experience in case management or a related field.
  • Strong communication and interpersonal skills, with the ability to work effectively with patients, families, physicians, and the multidisciplinary team.
  • Ability to analyze complex patient data and develop effective case management plans.
  • Knowledge of healthcare regulations, including CMS guidelines, and ability to apply this knowledge in a practical setting.
  • Strong organizational and time management skills, with the ability to prioritize multiple tasks and meet deadlines.
  • Ability to maintain confidentiality and handle sensitive patient information with discretion.
What We Offer

Vista Health System offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and compassionate RN Case Manager looking for a challenging and rewarding role, we encourage you to apply.


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