RN Care Manager -PSMC

Phoebe Putney Memorial Hospital; Sumter (SC); Vor Ort; USD 70.000 - 100.000; Vollzeit

Zusammenfassung

Phoebe Putney Memorial Hospital is seeking a Nurse Case Manager to coordinate care from admission through discharge across PPHS facilities. The role emphasizes first-level clinical reviews, utilization management, and collaboration with a multidisciplinary team to ensure quality, timely, and cost-effective case management for assigned patients.

Under supervision of the Care Management leadership, the CM develops and implements discharge plans and coordinates with nursing, social work, and

Qualifikationen

• Requires RN licensure in Georgia
• Experience in acute care settings and case management preferred
• Understanding of utilization review and discharge planning processes

Aufgaben

• Perform utilization review and discharge/transition planning per caseload
• Collaborate with physicians, nurses and social work to coordinate patient care
• Address payer requirements and ensure efficient resource use
• Escalate issues to Team Lead or Director CM when needed

Kenntnisse

Care coordination

Patient advocacy

Utilization review

Discharge planning

Ausbildung

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Jobbeschreibung

Job Number:
35419

Location:
Sumter Campus

Street Address:
126 US-280

City, State:
Americus, Georgia

Zip Code:
31719

Department:
PSMC CARE MANAGEMENT

Shift:
First Shift

Job Type:
Full time

Posted Date:
2026-10-27

Job Description Summary

The Nurse Case Manager (CM) is responsible for care coordination of patients along their continuum from point of entry through discharge. The CM will address issues related to appropriate and timely admission, discharge, and care for patients receiving inpatient and observation care and services at PPHS facilities. The Care Manager performs first level clinical reviews according to hospital approved clinical criteria and in accordance with the Care Management Program's Utilization Plan and payer specific requirements. He/she will address utilization of resources for efficient and effective care delivery at the appropriate level of care. The Care Manager collaborates with social work, physicians, nurses and multidisciplinary team, lending professional care management expertise to ensure quality, timely and cost effective case management for an identified patient population and addresses issues or patterns in patient readmission. In this role the Care Manager is accountable for facilitating clinical patient progression through a defined plan of care to achieve optimal outcomes. Under the direction of the Care Management Team Lead, the Director of Care Management, and through coordination with nursing, social work, physicians and other members of the interdisciplinary team, the Care Manager develops, facilitates and implements appropriate case management and discharge plans.

Description

JOB SUMMARY
The Nurse Case Manager (CM) is responsible for care coordination of patients along their continuum from point of entry through discharge. The CM will address issues related to appropriate and timely admission, discharge, and care for patients receiving inpatient and observation care and services at PPHS facilities. The Care Manager performs first level clinical reviews according to hospital approved clinical criteria and in accordance with the Care Management Program's Utilization Plan and payer specific requirements. He/she will address utilization of resources for efficient and effective care delivery at the appropriate level of care. The Care Manager collaborates with social work, physicians, nurses and multidisciplinary team, lending professional care management expertise to ensure quality, timely and cost effective case management for an identified patient population and addresses issues or patterns in patient readmission. In this role the Care Manager is accountable for facilitating clinical patient progression through a defined plan of care to achieve optimal outcomes. Under the direction of the Care Management Team Lead, the Director of Care Management, and through coordination with nursing, social work, physicians and other members of the interdisciplinary team, the Care Manager develops, facilitates and implements appropriate case management and discharge plans.

EDUCATION

• Associate's Degree in Nursing from a state accredited school (Required)
• Bachelor's Degree in Nursing from a state accredited school (Preferred)

EXPERIENCE

• 1+ year of recent acute care experience with relevant clinical experience in the assigned area.
• 1+ year of Case management or utilization review experience in a hospital or related setting (Preferred)

CERTIFICATIONS

• Registered Nurse (RN) with current Georgia license (Required)
• Certified Case Manager upon hire (Preferred)

ESSENTIAL FUNCTIONS

JOB KNOWLEDGE - CARE MANAGER:

• Understands and fulfills job responsibilities and expectations and applies knowledge and skills to function proficiently in CM role. Serves as Patient Advocate in support of Hospital mission and goals.
• Maintains knowledge of current federal, state and accreditation requirements applicable to utilization review and discharge planning; demonstrates skill in the application of this knowledge.
• Possesses current and comprehensive skill and knowledge to perform all parts of the job effectively and efficiently.
• Exhibits ability to learn and apply new skills, professional knowledge and expertise.
• Requires minimal day-to-day direction to perform responsibilities.
• Acts as resource in area of specialty and is able to share best practices and answer questions as needed.

UTILIZATION MANAGEMENT AND DISCHARGE PLANNING:

• Performs utilization review and discharge/transition planning functions and activities per assigned caseload or unit. Applies knowledge of regulations and payer requirements to maintain full compliance, assure patient rights and avert payer denials or patient liability
• Notifies the Physician Adviser designee, or Chief Utilization Officer, as needed regarding physician issues, patient care issues or quality issues. Seeks guidance and intervention as necessary; discusses or escalates cases to Team Lead or Director CM for guidance or administrative support.
• Performs prospective or con