Case Management Nurse

Medasource; Indiana; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking an RN Case Manager to plan and coordinate patient care from pre-admission through post-discharge. This full-time, remote position requires collaboration with a multidisciplinary team and effective discharge planning. Candidates should have a nursing degree and an active RN license in Indiana, with preferred experience in case management and knowledge of Medicare/Medicaid guidelines.

Qualifications

• 3-5 years of Case Management experience preferred.
• Active RN license in Indiana or Nurse Licensure Compact (NLC) RN license required.
• Certification in Case Management preferred.

Responsibilities

• Plans and coordinates care for patients from pre-admission through post-discharge.
• Ensures patients receive appropriate services and transitions to post-discharge care.
• Works with third-party payers to ensure coverage.

Skills

Case Management

Patient Care Coordination

Discharge Planning

Knowledge of Medicare/Medicaid

Education

Associate's or Bachelor's Degree in Nursing

Tools

Cerner

MCCM

SMS

Windows

Job description

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Job Details

• Location: Remote, must be local to Indiana
• Duration: 6-month Contract-to-Hire
• Schedule: Full-time, Monday-Friday, 8am-5pm EST

Summary

The RN Case Manager plans and coordinates care for patients from pre-admission through post-discharge by working collaboratively with the multidisciplinary team. Ensures that patients are assigned the appropriate level of care, receive the appropriate services, and are transitioned to the appropriate post-discharge level of care. Performs accurate, timely, and effective discharge planning for patients. Works with third-party payers to ensure coverage. Administers education and prevention programs.

Requirements

• 3-5 years of Case Management experience preferred.
• Associate's or Bachelor's Degree in Nursing required.
• Experience with Complex and/or Transition of Care Case Management preferred.
• Experience working in a managed care environment preferred.
• Requires an active Registered Nurse (RN) license in Indiana or an active Nurse Licensure Compact (NLC) RN license.
• Certification in Case Management preferred.
• Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation, is preferred.
• Knowledge of Medicare/Medicaid, insurance, and regulatory guidelines is preferred.
• Ability to comprehend third-party contractual arrangements is preferred.
• Understanding of the third-party denial and appeal process is preferred.
• Requires knowledge of various software applications including Windows, Cerner, MCCM, and SMS.