Case Manager RN – Care Coordination & Discharge

Valley View Hospital; Glenwood Springs (CO); On-site; USD 55,000 - 83,000; Full time

Benefits offered by this job

Employer paid life coverage

Flexible Spending Account (FSA)

PTO / leave benefits

Tuition Assistance

403(b) retirement plan

Employee Assistance Program

Employee discounts

Job summary

Valley View Hospital in Glenwood Springs, CO, is seeking a Full-Time Case Manager RN to join the Case Management team. The role coordinates discharge planning, utilization review, and patient advocacy across care settings, with emphasis on CMS compliance and regulatory standards.

Qualified candidates will be a graduate of an accredited nursing or social work program, hold a CO license or eligibility, and preferably have a BSN or LCSW with 2+ years acute hospital experience.

Qualifications

• Graduate of an accredited nursing or social work program.
• Current Colorado license or ability to obtain.
• BSN or LCSW preferred.
• Minimum two years acute hospital experience preferred.
• Case Management and Utilization Review experience preferred.
• Knowledge of medical necessity criteria preferred.
• Epic or electronic health record experience preferred.

Responsibilities

• Conducts comprehensive assessments of patient needs and discharge barriers.
• Develops and updates individualized plans of care with the interdisciplinary team.
• Initiates discharge planning at admission and coordinates post-acute services.
• Ensures patient choice requirements are met in accordance with CMS regulations.
• Coordinates transitions between levels of care and community resources.
• Performs initial and concurrent utilization review using approved criteria.
• Reviews admissions, observation stays, continued stays, and discharge readiness.
• Collaborates with providers regarding medical necessity and level-of-care determinations.
• Participates in denial prevention, denial management, and appeal activities.
• Monitors observation status, IMM and MOON compliance, and payer requirements.
• Identifies opportunities to reduce avoidable delays and excess length of stay.
• Supports accurate clinical documentation.
• Maintains compliance with CMS Conditions of Participation, EMTALA, HIPAA, state and federal regulations, and Joint Commission standards.
• Completes required discharge planning and utilization review documentation.
• Participates in performance improvement initiatives.
• Monitors outcomes, readmissions, length of stay, and transition-of-care metrics.
• Advocates for patients and families and supports informed decision-making.

Skills

Case Management

Utilization Review

Discharge Planning

Patient Advocacy

Regulatory Compliance

Quality Improvement

Education

BSN

LCSW

Graduate of accredited nursing or social work program

Tools

Epic

Job description

Valley View Hospital in Glenwood Springs, CO, is seeking a Full-Time Case Manager RN to join the Case Management team. The role coordinates discharge planning, utilization review, and patient advocacy across care settings, with emphasis on CMS compliance and regulatory standards.

Qualified candidates will be a graduate of an accredited nursing or social work program, hold a CO license or eligibility, and preferably have a BSN or LCSW with 2+ years acute hospital experience.