RN Case Manager

Qualifications for RN Case Manager:

• The Case Manager is responsible for managing a continuum of care from admission through discharge for assigned patients.


• Partners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values.


• Participates in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan.


• Collects and reports utilization data and quality information, such as delays in service, possible avoidable days, provider preventable conditions, readmissions, and length of stays, etc.


• Assists in preparing UM/QI case issues, gathering requested records/responses.


• Consults with the nursing staff working directly with clients in the nursing care areas.


• Maintains current knowledge of evidence based nursing care practices.


• Educates nursing staff about state and federal rules and regulations in preparation for accreditation.


• Evaluates and verifies employee performance through the review of completed work assignments and work techniques.


• Ensures delivery of quality care to patients, enhancement of business development, and continuous improvement of agency efficiency and fiscal success.


• Provides instruction to hospitalized members and their families; and serves as liaison between the member, the physician, the hospital and the Plan.


• Case Manager completes appropriate, accurate and timely, documentation into EMR system every shift

Requirements for Case Manager:

• Active CA Registered Nurse


• Acute clinical experience


• Experienced in case management, UR/UM


• Possesses knowledge of applicable regulatory standards and is able to perform audits based upon these standards


• Solid experience dealing with UR concepts


• Computer literate