Lead RN Case Manager

Cleveland Clinic; Martin (AL); On-site; USD 90,000 - 110,000; Full time

Job summary

Cleveland Clinic Martin Health seeks a Lead RN Case Manager to join the CRP Case Management team. You will coordinate patient care across the continuum, work with post-acute providers, and ensure effective discharge planning. The role requires strong communication and leadership to improve outcomes and documentation accuracy.

The position operates days with on-call requirements, within a renowned health system known for patient-first care and collaboration with physicians and payors.

Qualifications

• RN with Florida license (active) or eligibility
• CCM certification required within one year of eligibility
• Six years in care management, utilization review or discharge planning
• Excellent communication, negotiation and leadership skills
• Strong analytical and data management abilities
• Strong knowledge of discharge planning and managed care reimbursement
• Ability to work with physicians, payors and patients/families independently

Responsibilities

• Promote optimal clinical and resource outcomes.
• Facilitate pre-certification and payer authorizations.
• Coordinate across the continuum to address barriers to care.
• Lead process improvements to improve outcomes.
• Serve as clinical documentation resource for coders and staff.
• Collaborate with physician relations and leadership to align goals.

Skills

Interpersonal skills

Leadership

Analytical

Care coordination

Documentation support

Negotiation

Education

BSN or Healthcare degree

CCM certification

Tools

EMR systems

Care management software

Job description

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Lead RN Case Manager

Location

Stuart

Facility

Martin Health North

Department

CRP Case Management-Cleveland Clinic Martin Health

Job Code

000253

Shift

Days + Call

Schedule

8:00am-4:30pm

Job Summary

Job Details

Join the Cleveland Clinic Florida team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

The Lead RN Case Manager acts as the key information and education resource for the interdisciplinary team and works to develop organization-wide approaches to problem solving. Using your effective communication and interpersonal skills, you will help to prepare a plan of care that is patient specific and coordinate with post-acute providers to ensure continuity of care after discharge. This is a very hands-on team who feel valued in the work they do each day knowing that they have a direct impact on the patient.

A caregiver in this position works days from 8:00AM – 4:30PM, with on-call requirements.

A caregiver who excels in this role will:

• Promote the achievement of optimal clinical and resource outcomes.

• Facilitate pre-certification and payer authorization processes.

• Facilitate the collaborative management of patient care across the continuum, proactively identify and effectively address barriers for identified patient populations.

• Identify, develop and apply process improvement methodologies in evaluating and improving outcomes of care.

• Act as the expert involved in the clinical documentation efforts and serving as a clinical resource for coders and staff ensuring that documentation accurately reflects severity of illness and intensity of service.

• Be utilized as a sought-out expert with physician relations and communications.

• Support and act as a role model for the compliance of team members ensuring regulatory requirements are met.

• Work with leadership to align goals and visions.

Minimum qualifications for the ideal future caregiver include:

• Registered Nurse and a Bachelor’s of Science in Nursing (BSN) OR Bachelor's in Healthcare field

• Current and valid license to practice as a Registered Nurse (RN) in Florida

• Case Manager Certification (CCM) required within one year of eligibility

• Six years of experience in Care Management, Utilization Review or Discharge Planning in a Healthcare setting

• Excellent interpersonal communication and negotiation skills

• Demonstrated leadership skills

• Strong analytical, data management and PC skills

• Current working knowledge of discharge planning, utilization management, Care Management, performance improvement and managed care reimbursement

• Understanding of pre-acute and post-acute venues of care and post-acute community resources

• Strong organizational and time management skills

• Can work independently and exercise sound judgment in interactions with physicians, payors and patients and their families

Preferred qualifications for the ideal future caregiver include:

• Master’s of Science in Nursing (MSN) or Master's in Healthcare related field

Physical Requirements:

• Requires direct patient care.

• Requires extensive walking, telephone use, bending, reaching, and lifting items weighing twenty pounds or less.

• Must be able to work well under pressure and maintain professional demeanor under adverse conditions.

• Extensive reading, writing, use of pagers, fax machines, computers, and copiers.

• Sedentary Work - Exerting up to 10 pounds of force occasionally (Occasionally: active or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.

• Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.

• Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/

Please review the Equal Employment Opportunity poster.

Cleveland Clinic is pleased to be an equal employment opportunity employer.