POSITION SUMMARY – RN Case Manager

POSITION DUTIES –

• Serves as an Outpatient/Inpatient Case Manager/Utilization Review Registered Nurse (CM/UR RN) for TCRHCC and is responsible for direct supervision and supportive contact for the specific group of identified patient assignments and high-risk patients.
• Responsible for designing and managing a continuum of care focusing on empowering clients to achieve demonstrable outcomes and self-sufficiency.
• Responsible for assessment, service planning, and resource acquisition, monitoring progress and initiating and responding to emerging client needs.
• Performs Utilization Review and Management/Clinical Documentation Chart Reviews of patients in the acute clinical care setting, ambulatory care setting and will conduct UR reviews as required.
• Works closely with the Social Work (MSW) Case Manager on Discharge Planning and Care Transitions.
• Works closely with the Physician Advisor and participate on the UR Committee as well as conduct Clinical Documentation Chart Reviews related to peer review, financial or insurance determination, or claims denials.
• Links the client with Community Social Service providers, health care providers, substance abuse, and mental health providers to achieve specific goals.
• Has experience working with culturally diverse low-income populations having multiple barriers to self-sufficiency such as: illiteracy, welfare dependency, domestic violence, substance abuse, and mental health issues.
• Works with a multidisciplinary team within the service delivery setting.
• Be committed to Case Management Services and have some collaboration with Purchased and Referred Care (PRC) formally known as Contract Health Services, providing assistance with the PRC Case Specialist.
• Responsible to the Director of Care Coordination.

MINIMUM REQUIRED QUALIFICATIONS –

• ADN
• Valid, current, full and unrestricted RN license
• AHA BLS
• Knowledge of the case management, purchased referred care and utilization review processes
• Knowledge of electronic health record systems
• 3 years of clinical nursing experience performing direct patient care with at least 2 years in an Inpatient setting on a medical-surgical unit, PACU, or higher acuity Inpatient unit (ICU, Step-Down, Telemetry, etc.) or home health (direct care)
• 1 year of traveling experience as contractor

LENGTH OF ASSIGNMENT – 13 weeks

SHIFT / HOURS PER WEEK – M-F 8am-5pm Weekend on call rotation, would be 1 weekend a month

SYSTEMS – Allscripts

START DATE – 4/21/2025