Case Manager RN

Prime Healthcare; Mission (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Mission Regional Medical Center in Mission, TX is seeking a qualified case manager to oversee admission and discharge processes, promoting efficient and patient-centered care.

The role focuses on quality, cost containment, and coordination with care teams, with experience in discharge planning and knowledge of criteria like Milliman and InterQual preferred.

Qualifications

• Bachelor's degree in a related field; 1 year case management or discharge planning experience.
• Basic to intermediate computer skills.

Responsibilities

• Quality and resource management of admitted patients across the care continuum.
• Promote cost containment and coordinate care with providers for seamless delivery.
• Conduct admission and concurrent review for medical necessity, intensity of service and severity of illness.

Skills

Case management

Discharge planning

Nursing management

Computer skills

Education

BSW or related bachelor's degree

Tools

Milliman Criteria

InterQual Criteria

Job description

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Mission Regional Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Mission Regional Medical Center is a 297-bed, non-profit hospital that provides inpatient and outpatient hospital services to the people of the Rio Grande Valley. Rated one of the top hospitals in the country for clinical excellence in many services including maternity and orthopedic care, Mission Regional Medical Center has been offering quality healthcare, close to home, for over 60 years. For more information visit www.missionrmc.org.

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1. BSW or other bachelor's degree in a related field. At least one year experience in case management, discharge planning or nursing management; or2. Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

1. Minimum 5 years of acute care experience preferred.2. CCM or obtained within 1year3. Current BCLS certificate preferred.4. Knowledge of Milliman Criteria and InterQual Criteria preferred.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf