Registered Nurse Case Manager

Prime Healthcare; Riverdale (GA); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Prime Healthcare is seeking an RN Case Manager at Southern Regional Medical Center, Riverdale, GA. The role oversees patient care from admission to discharge, coordinating with physicians, nurses, social workers, and other providers to ensure quality outcomes.

The position requires substantial nursing experience, active RN licensure, and expertise in case management and discharge planning. This on-site role operates during day shifts with 8-hour days, and emphasizes utilization review and

Qualifications

• Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state RN license.
• Five years acute care nursing experience preferred; at least one year in case management, discharge planning or nursing management.
• Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school of Social Work for Licensed Clinical Social Worker; RN Case Manager 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.

Responsibilities

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

Skills

RN License

Case Management

Discharge Planning

Utilization Review

Communication

Education

BSN or higher

Social Work degree (LCSW)

Tools

Milliman Criteria

InterQual Criteria

Job description

Overview

Shift’s Available: Days

Employment Type: Full Time

Hours: 8 hour days hsifts 8am-5pm

Location: Southern RegionalMedical Center– Riverdale, GA

We are seekinganRNCase Manager,also referred to asaRegistered NurseCase ManagerorRNClinical Case Manager.AnRNCase Manager willoversee 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 alsoconductdischarge planning,utilizationreview, andhelpingpatients navigate insurance and healthcare systems.

Responsibilities

• Patient Assessment: evaluate patients’ medical, psychosocial, and discharge needs upon admission and throughout their stay

• Care Coordination: develop and implement individualized care plans in collaboration with the healthcare team to ensure effective treatment andtimelyinterventions

• Discharge Planning: coordinate safe andappropriate dischargeplans, including referrals to rehab, home health, or long-term care facilities

• UtilizationReview: monitorthe use of hospital resources and services to ensureappropriate careand avoid unnecessary treatments or extended stays

• Patient and Family Education: help patients and families understand care plans, post-discharge instructions, and available resources

• Advocacy: advocate 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