Case Manager - RN

Proforma Health; Aiken (SC); On-site; USD 65,000 - 90,000; Full time

Job summary

Proforma Health is seeking a full-time Case Manager (RN) with a background in acute care settings. The role emphasizes chart reviews, denial risk reduction, and close collaboration with payers and healthcare teams to optimize patient progression and discharge planning.

You will coordinate with social workers and discharge planners to ensure timely transitions, identify avoidable hospital days, and support documentation that justifies hospital stays.

Qualifications

• RN with acute care hospital or related setting experience.
• 3 years of relevant nursing experience.
• Knowledge of insurance, Medicare criteria, healthcare financial systems, and computer proficiency.

Responsibilities

• Perform chart reviews for admission, concurrent, and retrospective cases to ensure documentation accuracy, appropriate stay, and reduce denial risks.
• Collaborate with payers and healthcare teams to manage patient progression, discharge planning, and resource utilization.
• Coordinate with social workers and discharge planners to facilitate timely transitions of care, identify avoidable hospital days, and support documentation justifying hospital stays.
• Manage denied cases and ensure efficient patient flow; support interdisciplinary collaboration, process improvement, and education.

Skills

Chart reviews

Payer collaboration

Discharge planning coordination

Interdisciplinary collaboration

Process improvement

Education

Diploma or Associate degree in nursing

BSN preferred

Job description

We are seeking a full-time Case Manager (RN) with a strong background in acute care hospital or related settings, including utilization review or case management experience. The role involves performing chart reviews for admission, concurrent, and retrospective cases to ensure documentation accuracy, appropriate stay, and reduce denial risks.

Responsibilities include collaborating with payers and healthcare teams to manage patient progression, discharge planning, and resource utilization. The case manager works closely with social workers and discharge planners to facilitate timely transitions of care, identify avoidable hospital days, and support documentation that justifies hospital stays.

Qualifications require a diploma or associate degree in nursing (BSN preferred), a current RN license in SC or a compact state, and a minimum of 3 years of relevant experience. Knowledge of insurance, Medicare criteria, healthcare financial systems, and computer proficiency are essential.

Key duties involve managing denied cases, coordinating with insurance for payment authorizations, and ensuring efficient patient flow. The role emphasizes interdisciplinary collaboration, process improvement, and education to optimize patient care and hospital resource use.