Description

American Traveler is seeking an experienced RN Case Manager for a utilization management and discharge planning role in an acute care hospital setting, requiring an active CA RN license and a minimum of 2 years of direct acute care experience.

Details

• Acute care hospital setting with additional exposure to long-term acute care, rehab, and skilled nursing environments
• Case Management/Utilization Management unit with an average daily census of 30 patients and approximately 18 visits per day
• Adult patient population
• Schedule is Monday through Friday, 5x8-hour shifts, 7:30 AM–4:00 PM, with weekends off
• Block scheduling type
• Floating is required
• No on-call responsibilities
• Epic EMR used for documentation

Requirements

• Active CA RN license in good standing required
• Current BLS certification required
• Certification in Case Management (CCM) preferred
• Minimum ADN required; BSN preferred
• Minimum 2 years of direct patient care experience in an acute care setting required; prior case management experience in an acute care setting strongly preferred
• Must be actively functioning as an RN Case Manager with hands-on experience in inpatient care coordination, discharge planning, and post-acute clinical payer authorization
• Proficiency with InterQual and Milliman criteria required
• Knowledge of CMS, DRG, ICD-10, CPT coding, HIPAA, HEDIS, NCQA, Joint Commission standards, and Workers' Compensation required
• Strong organizational, analytical, and independent decision-making skills required

Additional Information

• Responsible for utilization management, quality assurance, and discharge planning for assigned patients within the health system
• Performs admission criteria reviews, concurrent and continued stay reviews, retrospective reviews, and appeals and denials management
• Conducts medical necessity determinations and applies InterQual and Milliman guidelines
• Ensures compliance with regulatory requirements including CMS, The Joint Commission, OSHA, HIPAA, and NCQA standards
• First-time travelers will not be considered for this position
• All time-off requests must be disclosed at the time of consideration
• Note: This position is located in a high cost-of-living area; candidates are encouraged to research local living expenses before applying