Clinical Case Manager RN - Discharge & Care Coordination

Riverview Health; Noblesville (IN); On-site; USD 65,000 - 90,000; Full time

Job summary

Riverview Health is seeking a Clinical Case Manager to coordinate hospitalization processes, conduct utilization reviews, review medical records, and collaborate with payers to ensure proper reimbursement and timely discharge planning.

The role emphasizes coordinating with the multidisciplinary team, ensuring compliant care paths, and facilitating transitions from hospital to home or post-acute settings.

Qualifications

• Minimum: 2 years in utilization review and discharge planning.
• Preferred: 5 years in utilization review and discharge planning.
• Licensed as RN or Social Worker (as appropriate to education).

Responsibilities

• Coordinate admission and concurrent reviews to prevent payer denials.
• Communicate bed status and level of care criteria with the care team.
• Support and document utilization reviews, appeals, and outcomes.
• Assist with discharge planning and post-discharge arrangements.
• Research regulations and payer requirements to determine next steps.
• Provide patient/family advocacy and education about discharge options.

Education

Associate Degree in Nursing (ASN)

BA/BS in Social Work

BSN

MSW in Social Work

Job description

Riverview Health is seeking a Clinical Case Manager to coordinate hospitalization processes, conduct utilization reviews, review medical records, and collaborate with payers to ensure proper reimbursement and timely discharge planning.

The role emphasizes coordinating with the multidisciplinary team, ensuring compliant care paths, and facilitating transitions from hospital to home or post-acute settings.