Case Manager RN NE, Full time Day

Socket.dev; Watertown (WI); On-site; USD 80,000 - 105,000; Full time

Job summary

ScionHealth is seeking an RN–Case Manager to assess, plan, coordinate, and monitor care for patients, ensuring high-quality outcomes and regulatory compliance. The role emphasizes discharge planning, collaboration with interdisciplinary teams, and effective communication with payers.

Ideal candidates hold an Associate Degree in Nursing with preferred BSN, and have experience in acute or post-acute settings, with strong EMR proficiency and patient advocacy skills.

Qualifications

• Advanced case management principles and patient advocacy.
• Discharge planning and care coordination across disciplines.
• Familiarity with payer requirements and utilization review.
• Knowledge of CMS/Medicare/Medicaid guidelines.

Responsibilities

• Assess, plan, coordinate, and monitor healthcare services for patients.
• Review documentation and ensure timely, cost-effective care.
• Arrange post-discharge services including home health and equipment.
• Collaborate with physicians, patients, families, and teams.
• Communicate with payers for authorization and approvals.
• Document activities in the EMR and participate in quality improvement.

Skills

Case management

Critical thinking

Communication

Payer/Utilization knowledge

EMR proficiency

Independence

Privacy & ethics

Education

Associate Degree in Nursing

BSN preferred

Tools

EMR 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

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