Case Manager/Utilization Review Nurse - Part Time

Wilson Health; Sidney (OH); In loco; USD 47.000 - 58.000; Part-time

Vantaggi offerti da questo lavoro

Employer Direct Care Clinic

PTO from day one

Medical Insurance (HDHP / PPO)

HSA with employer contribution

Life Insurance

Long-Term Disability Insurance

Voluntary Insurance (Accident, etc.)

Retirement plan with immediate company

Tuition Assistance

On-site gym access

Descrizione del lavoro

Wilson Health is seeking a part-time Registered Nurse to join the Case Management team. The role focuses on coordinating patient care, supporting safe discharge planning, and ensuring appropriate utilization of healthcare resources to promote positive outcomes across the continuum of care.

The Case Management RN works with physicians, nursing, payers, and community resources to identify patient needs, coordinate services, address barriers to discharge, and support appropriate levels of care.

Competenze

• Graduate of an accredited school of nursing required.
• BSN preferred.
• Previous Case Management, Utilization Review, Discharge Planning, or acute-care nursing experience strongly preferred.
• Knowledge of utilization review, medical necessity, discharge planning, and coordination of care preferred.
• Experience working with physicians, nursing, Revenue Cycle, payers, and community resources is beneficial.

Mansioni

• Perform utilization review activities to evaluate admission, continued stay, level of care, documentation, and standards of care.
• Assess patients for physical, psychological, functional, social, environmental, and financial needs affecting care or discharge.
• Develop and coordinate discharge plans with patients, families, physicians, nursing, and community providers.
• Identify barriers to discharge and coordinate resources for safe transitions of care.
• Review treatment plans and alternatives to coordinate the most appropriate plan of care.
• Participate in multidisciplinary rounds and collaborate on patient progression and discharge readiness.
• Serve as a resource regarding utilization management, LOS, and discharge planning needs.
• Facilitate physician documentation to support medical necessity and best-practice standards.
• Refer cases to Utilization Review Physician Advisor.
• Assist with inpatient medical necessity denials and appeals.

Conoscenze

Clinical assessment

Utilization review

Discharge planning

Care coordination

Communication

Documentation

Formazione

RN degree

BSN preferred

Descrizione del lavoro

Key Perks and Benefits

• Access to Employer Direct Care Clinic. Free medical care and pharmacy services for eligible employees and dependents covered by Wilson Health's medical insurance plan.
• Generous paid time off (PTO) program beginning day one, designed to support work-life balance, rest, and time with family.
• Medical Insurance: Choose from two High - Deductible Health Plan (HDHP) options or a PPO plan, along with Dental and Vision coverage. Benefits begin on the first of the month following your hire date.
• HSA with employer contribution for eligible health plans; FSA for medical and dependent care expenses.
• Company-paid Life Insurance and Long-Term Disability Insurance
• Voluntary Accident, Critical Illness, and employee and dependent Life and AD&D Insurance.
• Industry-leading retirement plan – employer contributions begin day one with no waiting period for participation.
• Tuition Assistance Program
• Free access to an on-site gym, available 24/7, making it easy to prioritize your health and wellness before or after your shift.

Position: Case Management RN – Part Time

Employment Status

Part-Time

Department

Case Management

Hours

8:00am - 4:30pm, with every 3rd SATURDAY rotation required.

3 days per week, Monday as scheduled. - Days may vary.

Position Summary

Wilson Health is seeking an experienced Registered Nurse (RN) to join our Case Management team in a part-time capacity. The Case Management RN plays an important role in coordinating patient care, supporting safe and timely discharge planning, ensuring appropriate utilization of healthcare resources, and promoting positive patient outcomes throughout the continuum of care.

This position works collaboratively with physicians, nursing, ancillary departments, patients, families, payers, and community resources to identify patient needs, coordinate services, address barriers to discharge, and support appropriate levels of care.

The Case Management RN also assists with utilization review, clinical documentation, medical necessity reviews, and inpatient denial prevention and management.

Essential Duties & Responsibilities

• Perform utilization review activities to evaluate the appropriateness of admission, continued hospital stay, level of care, clinical documentation, and applicable standards of care.
• Assess patients for physical, psychological, functional, social, environmental, and financial needs that may affect their plan of care or discharge.
• Develop and coordinate individualized discharge plans in collaboration with patients, families, physicians, nursing, ancillary departments, and community providers.
• Identify potential barriers to discharge and proactively coordinate resources and services to support safe and timely transitions of care.
• Review treatment plans and available alternatives and assist in coordinating the most appropriate plan of care.
• Participate in multidisciplinary rounds and collaborate with the healthcare team regarding patient progression and discharge readiness.
• Serve as a resource to physicians, nursing, and ancillary staff regarding utilization management, estimated length of stay, avoidable hospital days, quality measures, and discharge planning needs.
• Facilitate appropriate physician documentation to support medical necessity, severity of illness, risk of mortality, complexity of care, and applicable best-practice standards.
• Refer appropriate cases to the Utilization Review Physician Advisor.
• Assist with inpatient medical necessity denials and appeals and collaborate with Revenue Cycle to identify opportunities to reduce preventable denials.
• Perform case reviews and audits to promote consistency with standards of care, documentation requirements, and appropriate utilization of services.
• Assist with data collection, analysis, reporting, and identification of opportunities for Case Management process improvement.
• Participate in continuous quality improvement initiatives throughout Wilson Health.
• Coordinate with outside agencies, post-acute providers, suppliers, and family members as necessary to support successful patient outcomes and transitions of care.
• Maintain accurate and timely documentation of Case Management activities.
• Manage an assigned patient caseload as determined by department needs.
• Maintain professional knowledge and participate in ongoing education and professional development.
• Perform additional duties as assigned within the scope of the position.

Education & Experience

• Graduate of an accredited school of nursing required.
• Bachelor of Science in Nursing (BSN) preferred.
• Previous Case Management, Utilization Review, Discharge Planning, or acute-care nursing experience strongly preferred.
• Strong knowledge of utilization review, medical necessity, discharge planning, and coordination of care preferred.
• Experience working collaboratively with physicians, nursing, Revenue Cycle, payers, and community resources is beneficial.

Licensure & Certification

• Current, active, unrestricted Registered Nurse (RN) license in the State of Ohio required.
• Case Management certification through ACMA, CMSA, or another recognized case management organization preferred.
• Must maintain all required licensure and certifications throughout employment.

Knowledge, Skills & Abilities

• Strong clinical assessment and critical-thinking skills.
• Knowledge of utilization review and medical necessity principles.
• Understanding of discharge planning and transitions of care.
• Ability to effectively coordinate services across multiple disciplines.
• Strong communication, organization, and problem-solving skills.
• Ability to communicate effectively with patients, families, physicians, clinical staff, payers, and community partners.
• Ability to identify barriers to care and develop appropriate solutions.
• Strong attention to documentation, regulatory requirements, and patient confidentiality.
• Ability to prioritize responsibilities and manage multiple patient needs in a fast-paced healthcare environment.

Join Wilson Health

As a Case Management RN at Wilson Health, you will have the opportunity to make a meaningful impact on patients and their families by helping coordinate the right care, at the right time, in the right setting. You will work alongside an interdisciplinary team committed to quality, collaboration, responsible resource utilization, and exceptional patient care.

Mission

To improve the health and wellness of our communities by delivering compassionate, quality care.

Vision

To be the most trusted choice for care in the communities serve.

Values

A.S.P.I.R.E. Always Serve with Professionalism, Integrity, Respect, and Excellence.

EOE (Equal Opportunity Employer)