Registered Nurse Case Manager

Southern Regional Medical Center; Riverdale (GA); On-site; USD 85,000 - 100,000; Full time

Job summary

Southern Regional Medical Center in Riverdale, GA is seeking a Registered Nurse Case Manager to oversee patient care from admission to discharge, coordinating with physicians, nurses, social workers and other providers to ensure quality, cost-efficient outcomes. Responsibilities include discharge planning, utilization review, patient education, and navigating insurance processes.

The ideal candidate has 5+ years of acute care nursing experience, RN license in Georgia, and proficiency with care

Qualifications

• Must hold a current state RN license (GA).
• 5+ years of acute care nursing experience is preferred.
• Experience in case management and discharge planning preferred.
• Knowledge of Milliman and InterQual criteria is a plus.
• Strong communication and collaboration with care teams required.

Responsibilities

• Assess patients’ needs and coordinate care from admission through discharge.
• Develop and implement individualized care plans with the healthcare team.
• Coordinate discharge planning, referrals, and transitions of care.
• Conduct utilization review to ensure appropriate use of hospital resources.
• Educate patients and families about care plans, medications, and post-discharge instructions.

Skills

Nursing expertise

Care coordination

Discharge planning

Utilization review

Communication skills

Education

GA RN license

LCSW (optional)

Tools

Milliman Criteria

InterQual Criteria

Basic computer skills

Job description

Overview

Shift’s Available : Days

Employment Type : Full Time

Hours: 8 hour days hsifts 8am-5pm

Location : Southern Regional Medical Center – Riverdale, GA

We are seeking a n RN Case Manager , also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager . An RN Case Manager will oversee and coordinate patient care from admission through discharge to ensure quality, cost-effective outcomes. They assess patients’ needs, develop care plans, and collaborate with physicians, nurses, social workers, and other providers to manage care transitions. RN Case Managers also conduct discharge planning, utilization review, and helping patients navigate insurance and healthcare systems.

Responsibilities

• Patient Assessment: e valuate patients’ medical, psychosocial, and discharge needs upon admission and throughout their stay
• Care Coordination: d evelop and implement individualized care plans in collaboration with the healthcare team to ensure effective treatment and timely interventions
• Discharge Planning: c oordinate safe and appropriate discharge plans, including referrals to rehab, home health, or long-term care facilities
• Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays
• Patient and Family Education: h elp patients and families understand care plans, post-discharge instructions, and available resources
• Advocacy: a dvocate for patient needs and preferences, ensuring care is aligned with their goals and values

Qualifications

Education and Work Experience

• Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.
• Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.
• Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.
• Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.
• Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.
• Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.
• Current BCLS (AHA) certificate upon hire and maintain current;
• Knowledge of Milliman Criteria and InterQual Criteria preferred.
• Experience and knowledge in basic to intermediate computer skills.
• Behavioral Violence Prevention Training within 3 months of hires and maintain current.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf