RN Case Manager- FT- Resource Management

Position

Summary

Under the general supervision of the Case Management Coordinator, the RN Case Manager acts as a patient advocate to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. The RN Case Manager identifies opportunities to reduce cost while ensuring the highest quality of care is maintained.

Review criteria are applied to determine medical necessity for admission and continued stay. The RN Case Manager provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

The RN Case Manager works collaboratively with interdisciplinary staff internal and external to the organization, and participates in quality improvement and evaluation processes related to the management of patient care. The case manager is on-site and available seven days a week, as well as holidays and, therefore, is required to work a weekend rotation and an occasional holiday and will required to be on call.

Position education/

Qualifications

• Graduate from an accredited school for nursing required.

• A valid license as a Registered Nurse with the State of Texas is required.

• Certification in Case Management (CCM) is highly desired.

• Candidate must demonstrate proficiency in both the English and Spanish language.

Job knowledge/

Experience

• Knowledge in the areas of case management and utilization management, experience with Managed Care and utilization management as it relates to third-party payers preferred.

• Three to five years clinical experience is required, with experience in a Hospital or acute care setting being strongly preferred

• Experience in use of InterQual and or Milliman criteria and review processes highly desirable.

Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review and discharge planning

Job Type: Full-time

Benefits

• 401(k)

• 401(k) matching

• Dental insurance

• Health insurance

• Life insurance

• Paid time off

• Vision insurance

Experience

• Case management: 1 year (Required)

License/

Certification

• RN License (Required)

Ability to Commute

• Edinburg, TX 78539 (Required)

Ability to Relocate

• Edinburg, TX 78539: Relocate before starting work (Required)

Work Location: In person