Clinical Resource Manager Case Manager

Saint Alphonsus; Boise (ID); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Full benefits package

Competitive compensation

Growth opportunities

Job summary

Saint Alphonsus is seeking a Clinical Resource Manager / Case Manager to lead hospital case management, utilization review, and discharge planning. The role collaborates with physicians and the care team to determine level of care and ensure smooth transitions for a defined patient group.

The incumbent will coordinate social services integration, provide real‑time decision support, and promote cost‑effective care while maintaining high standards and regulatory compliance.

Qualifications

• RN license in Idaho or Oregon.
• Idaho only: licensure by endorsement if moving from another compact state and residence update within 60 days.
• All colleagues must provide licensure or proof of application within 90 days of hire.
• BSN required; master’s degree preferred.
• Minimum 2 years of varied hospital clinical experience.
• Experience in case management, home health, and/or the insurance industry preferred.

Responsibilities

• Coordinate case management, utilization review, and discharge planning across departments and services.
• Collaborate with physicians and health‑care team to ensure appropriate level of care and smooth transitions.
• Provide education to staff on regulatory standards and reimbursement requirements.
• Assist with 30‑day readmission review and adherence to Medicare Conditions of Participation.
• Maintain dialogue with patients/families to support informed decisions and realistic expectations.
• Engage in resource planning and coordination with social services and external agencies.

Skills

Case management

Utilization review

Discharge planning

Interdisciplinary collaboration

Patient advocacy

Education

BSN

Master's degree preferred

Job description

CLINICAL RESOURCE MANAGER / CASE MANAGER

Employment Type: Full time | Shift: Day Shift

Provides hospital case management/utilization review and discharge planning collaboratively determining level of care needs beyond acute care, providing decision support to patients/families and physicians, managing patient and family expectations, and ensuring a smooth transition to the next level of care and services. Coordinates the integration of social services into patient care as appropriate. Coordinates the hospital activities concerned with case management/utilization review and discharge planning. Adheres to departmental goals, objectives, standards of practice, and policies and procedures. Ensures quality patient care and adheres to regulatory compliance. Provides concurrent assistance and support to physicians and other clinical members of the health care team in coordinating the delivery of services for a select group of patients. To help achieve quality clinical and cost outcomes, incorporates real‑time contacts with physicians, nursing, and ancillary care givers to establish specific treatment, cost, and transition targets and to facilitate transition planning.

Requirements

• RN license in Idaho or Oregon.
• Idaho only: if a nurse moves to Idaho from another compact state, apply for licensure by endorsement and update residence within 60 days of hire.
• All colleagues must provide licensure or proof of application for secondary state within 90 days of hire.
• BSN required; a master’s degree preferred.
• Minimum 2 years of varied hospital clinical experience.
• Experience in case management, home health, and/or the insurance industry preferred.

What you will do

• Know, understand, incorporate, and demonstrate the organization’s mission, vision, and values in behaviors, practices, and decisions.
• Demonstrate knowledge and skills to care for all assigned age groups (neonate, child, adolescent, adult, geriatric as applicable).
• Revenue management: ensure accuracy of documenting services and supplies provided to patients.
• Coordinate integration of social services/case management into patient care, discharge, and home planning processes with other departments, external service organizations, agencies, and healthcare facilities.
• Complete screening/assessment of physician‑assigned cases to determine medical necessity/status determinations and transition needs.
• Conduct concurrent medical record review using established criteria to determine correct level of care for acute patients; assist physicians with completing transfer and discharge orders; maintain knowledge of federal, state, and private agency review requirements and regulations.
• Provide education to all health care team members including physicians regarding requirements to meet regulatory standards.
• Promote effective and efficient utilization of clinical resources from admission to discharge.
• Initiate and present denial letters as appropriate; complete PASRRs for admission to skilled nursing facilities; deliver Condition Code 44 letters to patients and educate them on Medicare benefits.
• Research and locate resources for patients (e.g., assistance in competing medication applications for financial assistance through pharmaceutical companies, work closely with Patient Financial Advocates in Medicaid pending process, and work closely with outside facilities to obtain equipment when patients have limited funding).
• Communicate with physicians at regular intervals throughout hospitalization and develop an effective working relationship; assist physicians to maintain appropriate cost, cases, and desired patient outcomes.
• Introduce self to patient and family and explain clinical resource manager role and the process for patient and family to contact the manager.
• Serve as a patient advocate; enhance a collaborative relationship to maximize patients’ and families’ ability to make informed decisions.
• Participate in multidisciplinary patient care rounds and/or conferences as appropriate to review treatment goals, optimize resource utilization, provide family education, and identify post‑hospital needs.
• Utilize physician advisor referral as appropriate.
• Follow department established process in reviewing 30‑day re‑admissions.
• Follow established patient choice policy.
• Document assessment of primary and backup plans along with communications to patient, family, and care team.
• Document interventions taken to meet needs in Power Chart.
• Actively participate in department staff meetings and department sub teams.
• Ensure discharge planning compliance with Medicare Conditions of Participation/regulations and Joint Commission standards.

Colleagues enjoy competitive compensation with a full benefits package and opportunity for growth throughout the system.

Our Commitment

Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity, and respect. We are an equal‑opportunity employer and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.