RN CASE MANAGER

Actalent - Riverside, CA

Full-time - Entry Level

Riverside, CA

251-500 employees

Administrative and Support Services

About the position

The RN Case Manager Assistant is responsible for providing comprehensive case management for patients in skilled nursing facilities. This role involves coordinating with various team members, including nursing, rehab, discharge planning, and physicians, to ensure effective patient care and transition planning. The position may also require telephonic case management for the Special Needs Department as needed.

Responsibilities

• Conduct medical necessity screening and submit for Physician Advisor review.
• Care coordination and implementation of transition plans based on RN Case Manager and/or Social Worker assessments.
• Communicate with the interdisciplinary team during patient care conferences.
• Manage concurrent disputes and communicate with patients and families regarding the plan of care.
• Collaborate with physicians, office staff, and ancillary departments.
• Document accurately and completely in the electronic system.
• Maintain accurate patient demographic and insurance information.
• Identify and document potentially avoidable days.
• Identify and report over and underutilization of resources.
• Ensure the patient is in the appropriate status and level of care based on medical necessity and submit for secondary physician review.
• Advocate for the patient and hospital with payers to secure appropriate payment for services rendered.
• Complete clinical reviews and promote prudent utilization of resources.
• Identify appropriate level of care needs and assist with patient transition.
• Clarify orders related to admission status and patient management.

Requirements

• Registered Nurse (RN) license.
• Experience in an acute hospital setting (200-300 bed hospital) as a floor nurse or in clinical care.
• Discharge planning experience in a hospital setting.
• Experience with HealthConnect or EPIC systems.

Nice-to-haves

• Proficiency in Excel and data entry.
• Clinical experience in a hospital setting.