RN-RN Case Manager Job Description
RN-RN case manager
provides third-party payers with clinical information to assure reimbursement; and coordinates care with the treatment team , family and others as necessary.
RN-RN Case Manager Duties & Responsibilities
To write an effective RN-RN case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included RN-RN case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Collaborate with health care professionals and coordinate ancillary staff and demonstrate professional growth and development
Provide appropriate care for patients
Provide supportive casework
Ensure the timely and accurate completion and submission of all required documentation
Make referrals for patients and families both internally and externally when such referrals are necessary to promote the health and safety of patients
Telephonically managing the overall direction, treatment plan and utilization for the patient population for a commercial health plan
Reviewing all documentation of patient status' to determine appropriate direction of care
Ensure high quality community-based member care through appropriate allocation of member services and resources
Monitor and evaluate effectiveness of the care plan to ensure member/caregiver satisfaction with services
Act as a resource to staff in the planning and delivery of outstanding member care
RN-RN Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for RN-RN Case Manager
List any licenses or certifications required by the position: CPR, BLS, PRI, CCM, AHA, CM
Education for RN-RN Case Manager
Typically a job would require a certain level of education.
Employers hiring for the RN-RN case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Graduate, School of Nursing, Management, Health, Science, Associates, Healthcare, Interdisciplinary
Skills for RN-RN Case Manager
Desired skills for RN-RN case manager include:
ANA/CMSA Code of Ethics
Insurance carriers
Third party payer requirements
Various reimbursement mechanisms
Federal
Local funding along with community resources available
Patient care management
Practices as normally acquired through the completion of a Bachelor's Degree in Nursing
Related field
State
Desired experience for RN-RN case manager includes:
Complete documentation in computer database of all member care
Provide individual and group education and support to members and their families as needed
Identify barrier and develop innovation solutions to ensure quality of member care
Enter authorizations in CCMS to authorize the provision of services, specifically for a RN visits, PT visits, and authorizations for DME
Conduct monthly integrated clinical assessments telephonically with members on case load to review current status and service provision and satisfaction with services provided
Review and update care plans in accordance of needs of members on a monthly and on-going basis
RN-RN Case Manager Examples
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RN-RN Case Manager Job Description
Job Description Example
Our company is looking for a RN-RN case manager. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for RN-RN case manager
- Monitor continuity of medical services
- Review Plans of Care and ensure they adequately provide services
- Assist in coordinating MLTC care and services under the direction of the organization clinical leadership
- Ensure appropriate documentation is input into the system
- Review assessments of enrollees' physical and mental conditions to inform primary care managers
- Obtain reliable and timely information about physical, behavioral, and primary health care services to ensure safe and effective transitions across settings
- Conduct outreach calls to ensure minimum monthly contact and no service disruptions
- Review Gaps in Care directives, perform outreach
- Document efforts to close gaps
- Assume responsibility for coordinating patient care within the continuum of care among the interdisciplinary team
Qualifications for RN-RN case manager
- Provide ongoing assessment in case management of patients
- Assure compliance with utilization requirements relative to all customer types and contract requirements
- Maintain ongoing communication regarding patient care with physicians, referral sources, caregivers, patients, families
- Independently initiate assessments of situations
- Act as an advocate for an individual’s healthcare needs
- Actively participate in the revenue process which includes the appeal/denial process
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RN-RN Case Manager Job Description
Job Description Example
Our company is looking to fill the role of RN-RN case manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for RN-RN case manager
- Ensure and assist in developing, implementing, and monitoring the Person Centered Service Plan (PCSP)
- Serve as the lead of the IDT
- Collaborate with members of IDT to assist each Participant in accessing services as identified in the Participant’s Person-Centered Service Plan
- Conduct advocacy, communication, and resource management to promote quality, cost effective, positive outcomes
- Provide referral and coordination of other services in support of the Patient-Centered Service Plan
- Assist Participants to obtain needed medical, behavioral health, prescription and non-prescription drugs
- Patient medical needs
- Patients' ability to perform ADLs
- Benefit interpretation, assisted by Member Services
- Living arrangements pre- and post-hospitalization
Qualifications for RN-RN case manager
- Significant others available to assist
- Patient/family psycho-social status
- 2-4 years of previous Case Management experience in Managed Care
- 2+ years of Acute Care Inpatient experience
- 3+ year of Utilization Review / Management and Case Management experience
- Identify appropriate providers and facilities through the continuum of care
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RN-RN Case Manager Job Description
Job Description Example
Our innovative and growing company is hiring for a RN-RN case manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for RN-RN case manager
- Provide a patient-centered, interdisciplinary approach to health care and care coordination using comprehensive, evidenced-based care plans developed in concert with the patient/care giver and with the support of the provider
- Cultivates a strong, cohesive, team-oriented relationship with practice partners, including on-site and remote interaction where appropriate, whereby the practices care team considers the case manager as an extension of and integral part of the practices care delivery program
- Screens patients and conducts individualized clinical assessments of patients health concerns/needs
- Evaluates the patients progress in setting and meeting established goals and revises their individualized care plan accordingly
- As appropriate, performs transitions in care assessments for patients discharged from an in-patient hospital or skilled nursing facility
- Advocates, guides and intervenes on behalf of patients, their family and/or care givers, in concert with the PCP, in understanding and navigating the health care system, including the coordination of community resources
- Defines, evaluates and reports on desired and actual patient health outcomes in collaboration with the interdisciplinary care team
- In urgent and non-emergency situations, facilitates the escalation of high-priority, problem patient cases that require direct and/or immediate intervention by the physician care team
- Communicates, collaborates, and coordinates with team members, patients, and families to provide quality patient care and to ensure positive patient outcomes
- Ensures continuity of care through communication in rounds and written documentation
Qualifications for RN-RN case manager
- Proficiency in review criteria to support medical necessity and effective discharge planning
- Proficient with InterQual and MCG (formally Milliman)
- Previous experience with CHHA, Medicaid/Medicare, and Oasis
- 2+ years of hospital case management experience from an acute care facility with more than 200 beds
- Utilize applicable sources of information, identify and enroll patients requiring case management
- Assist the Patient Care Coordinator with the coordination of care for beneficiaries not under case management as needed
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RN-RN Case Manager Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of RN-RN case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for RN-RN case manager
- Perform attendant care supervisory visits in accordance with state, program and company policies
- Collaborate on cases for appeals / fair hearing
- Meet threshold amount for minimum required assessments per week
- Maintain all corporate compliance requirements and mandatory training completion
- Manages the member's Individualized Care Plans (ICP) and coordinates the Interdisciplinary Care Team (ICT) meetings, agendas and activities
- Performs home visits and hand on assessments when required
- Coordinates and collaborates member's needs with providers, community agencies, and medical management teams
- Participates in training and professional development and willingly performs all other duties assigned by the Medical Management manager
- Identifies the appropriate utilization of resources across the continuum of care
- Maintains patient/caregiver care plan compliance reporting
Qualifications for RN-RN case manager
- Experience in a Labor & Delivery and OB/GYN setting
- Knowledge of Medicaid and Managed Care
- Three years of recent nursing experience in case management within acute care hospital setting preferred
- 3-5 years experience as a Registered Nurse in an acute care settingCase Management experience is preferred
- Experience working with the OMRDD population
- Previous inpatient Case Management experience
5
RN-RN Case Manager Job Description
Job Description Example
Our company is searching for experienced candidates for the position of RN-RN case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for RN-RN case manager
- Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
- Coordinate internal and external resources to meet identified needs
- Negotiate rates of reimbursement, as applicable
- Assist in problem solving with providers, claims or service issues
- Communicate daily one on one with physicians to determine patient needs (either in person or via telephone)
- Review the patient’s medical record to determine the appropriateness of stay relative to the established inpatient criteria
- Identify patients who do not meet the inpatient criteria and addresses these issues with the physician (s) and healthcare team so that patients are provided care in the most appropriate setting
- Assist in the development of timely discharge plan to the next level of care with other healthcare team members so that continuity of care can be maintained along with the necessary orders and insurance approval obtained for these services prior to discharge
- Collaborate with the patient, family, physician, and healthcare team members to assess the individual patient’s healthcare needs and determine an individualized discharge plan
- Assist in coordinating the patient’s care by effectively collaborating with the physician(s) and healthcare team to provide high quality care and optimize the appropriate use of healthcare resources
Qualifications for RN-RN case manager
- Travel up to 10% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays
- A Minimum of three years medical/surgical/critical care RN experience is required
- Experience working with the Medicaid Home and Community Based Waiver Program is preferred
- Must have a desire to work with the senior and/or disabled population
- Must be comfortable working on computer
- A minimum of three years current experience in acute care, two of which are in medical-surgical services preferred - other clinical experience in acute care will be considered