Case Management RN bei None

About the Role:

The Case Management RN is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves conducting prospective, concurrent, and retrospective reviews to ensure optimal resource utilization and compliance with clinical guidelines and payer policies. This position ensures that patients receive high-quality, cost-effective care while promoting optimal health outcomes and patient satisfaction. The RN collaborates closely with multidisciplinary teams, including physicians, social workers, and other healthcare professionals. Additionally, the role involves continuous monitoring and evaluation of patient progress to initiate and maintain timely communication with payers to facilitate authorization processes.

Minimum Qualifications:

• Current and valid Registered Nurse (RN) license in Nebraska.
• Associates Degree in Nursing required.
• Proficiency in electronic medical records (EMR).
• BLS required upon hire.

Preferred Qualifications:

• Minimum of one year clinical nursing experience, 
• Accredited Case Manager (ACM) credential.
• Experience working with diverse patient populations and complex chronic conditions.
• Advanced training in care coordination, utilization review, or patient advocacy.
• Familiarity with regulatory requirements such as HIPAA, Medicare, and Medicaid guidelines.
• Excellent interpersonal and communication skills demonstrated in multidisciplinary team environments.
• Ability to work independently and manage multiple priorities.

Responsibilities:

• Coordinate and communicate with healthcare providers, patients, and families to ensure timely and appropriate delivery of services.
• Monitor patient progress and outcomes, adjusting care plans as necessary to meet evolving health needs.
• Document all case management activities accurately and maintain compliance with regulatory and organizational standards.
• Participate in interdisciplinary team meetings to discuss patient care plans and collaborate on problem-solving.
• Ensure adherence to ethical standards and confidentiality requirements in all aspects of case management.
• Proactively engage with insurance companies to obtain and renew necessary authorizations in a timely manner.
• Educate patients and their families on Medicare-related compliance notices and obligations.

A conditional job offer is contingent upon successfully passing a pre-employment drug test and background checks. A Physical Capacity Profile may be required for some positions.