Case Manager RN NE, Full time Day

ScionHealth; Watertown (WI); On-site; USD 70,000 - 95,000; Full time

Job summary

ScionHealth is seeking an RN–Case Manager to assess, plan, coordinate, and monitor healthcare services to meet patients' needs, promoting quality, regulatory compliance, and cost efficiency across the continuum of care.

The role emphasizes discharge planning, collaboration with physicians and families, and ensuring timely authorization with payers while maintaining patient advocacy and confidentiality.

Qualifications

• Associate Degree in Nursing is required.
• BSN is preferred.
• Current RN license in the state of practice or compact state.
• BLS certification is required within facility policy.

Responsibilities

• Reviews clinical documentation and coordinates care across departments.
• Performs discharge planning and arranges post-discharge services.
• Collaborates with physicians, patients, and families for quality care.
• Communicates with payers for authorization and continued stay approvals.
• Documents activities and education in the EMR.
• Participates in performance improvement and data collection.
• Conducts 48-hour post-discharge follow-up calls as applicable.
• Advocates for the patient and coordinates with providers and community resources.
• Assists readmission assessments and care coordination.
• Keeps updated with Medicare/Medicaid rules and CMS guidelines.

Skills

Case management

Discharge planning

Nursing

Patient advocacy

Communication

Education

Associate Degree in Nursing

BSN preferred

Tools

EMR software

Utilization management systems

Job description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

The RN–Case Manager is responsible for assessing, planning, coordinating, and monitoring the healthcare services and resources necessary to meet the individual needs of patients. This role ensures effective case management processes that promote optimal patient outcomes, quality of care, regulatory compliance, and cost efficiency across the continuum of care.

Essential Functions

• Reviews clinical documentation and coordinates care across departments to ensure medically necessary services are provided in a timely and cost-effective manner
• Performs discharge planning by identifying patient needs and arranging post-discharge services including home health, medical equipment, and rehabilitation
• Collaborates with interdisciplinary team members, physicians, patients, and families to support quality care and safe transitions
• Communicates with insurance providers and payers for authorization and continued stay approvals
• Documents all activities, decisions, communications, and patient education in the EMR
• Participates in performance improvement initiatives, utilization review, and data collection efforts for administrative reporting
• Conducts 48-hour post-discharge follow-up calls as applicable
• Advocates for the patient and serves as a liaison between healthcare providers, patients, families, and community resources
• Assists with readmission assessments and care coordination strategies
• Keeps current with Medicare/Medicaid rules, CMS guidelines, and payer requirements

Knowledge/Skills/Abilities/Expectations

• Advanced understanding of case management principles, patient advocacy, and discharge planning
• Strong critical thinking, time management, and problem-solving skills
• Excellent interpersonal and communication abilities
• Familiarity with utilization management, payer authorization processes, and EMR systems
• Capacity to work independently and collaboratively in a high-pressure environment
• Commitment to maintaining patient confidentiality and upholding ethical standards
• Ability to prioritize multiple responsibilities and adjust to changes in work schedule or patient needs

Qualifications

Education

• Associate Degree in Nursing, required
• Bachelor of Science in Nursing (BSN), preferred

Licenses/Certifications

• Current and valid Registered Nurse license in the state of practice or Compact State RN license
• Basic Life Support (BLS) – required within time frame specified in facility policy
• Accredited Case Manager (ACM) Certification as required by facility policy

Experience

• Minimum of 1-2 years of clinical experience in an acute hospital, clinic, home health, hospice, or mental health facility, required
• Previous case management experience preferred