Case Manager (RN)

Saint Francis Health System - Muskogee, OK

Part-time - Mid Level

Muskogee, OK

Nursing and Residential Care Facilities

About the position

The Case Manager (RN) is responsible for overseeing the patient's hospitalization process from pre-admission to discharge. This role involves coordinating with healthcare professionals to ensure cost-effective and medically appropriate care, applying clinical expertise to resource utilization, and leading discharge planning efforts.

Responsibilities

• Facilitate the patient's hospitalization from pre-admission through discharge.
• Coordinate with physicians, nurses, social workers, and other health team members.
• Apply clinical expertise and medical appropriateness criteria to resource utilization and discharge planning.
• Advise the healthcare team and provide leadership as needed.
• Review appropriateness of patient's admission and need for continued stay using established criteria.
• Ensure care and discharge plans are consistent with the patient's clinical course and needs.
• Initiate discharge planning within one business day by assessing patient needs.
• Identify and manage potential barriers to discharge proactively.
• Participate in multidisciplinary patient rounds.
• Obtain third-party payer certification and respond to requests for clinical information.
• Assist with medical necessity denials and perform appeals with medical staff assistance.
• Coordinate transitional planning processes with attending physician.
• Make referrals to social work and Complex Discharge Specialist as needed.
• Collect data on variances from quality screening criteria and medical opportunity days.
• Document assessments and discharge plans in a timely manner.

Requirements

• Valid multi-state or State of Oklahoma Registered Nurse License.
• Minimum of 3 years of clinical experience as a registered nurse.
• Strong clinical background and understanding of diagnostic/radiological and surgical procedures.
• Experience in utilization review or discharge planning preferred.
• Ability to utilize Microsoft Office, Excel, and database management.

Nice-to-haves

• Experience in a healthcare setting with a focus on case management.
• Familiarity with electronic health records (EHR) systems.

Benefits

• Limited benefit offerings due to part-time status.