RN Case Management

The Health Care Authority for Baptist Health, An Affiliate of UAB Health System; United States; On-site; USD 75,000 - 95,000; Full time

Job summary

Baptist Health in Alabama is seeking an RN Case Manager to coordinate discharge planning and utilization management. You will work with physicians, nursing staff and other health professionals to optimize resource use, ensure high-quality patient care, and support accurate documentation.

Responsibilities include admission, continued stay and discharge reviews, collaboration with payers to ensure appropriate reimbursement, and compliance with regulatory guidelines.

Qualifications

• Nursing degree with active RN license.
• 2+ years hospital case management experience.
• Knowledge of utilization management and discharge planning.
• Case Manager certification preferred.

Responsibilities

• Coordinate discharge planning and care coordination for assigned caseload.
• Perform utilization management reviews from admission to post-discharge.
• Collaborate with interdisciplinary team and payers to optimize resources.
• Reconcile orders and ensure compliance with regulations and guidelines.

Skills

Communication skills

Independence

Interpersonal skills

Computer skills

Attention to detail

Education

Bachelor's degree in Nursing

Active RN license

Case Manager certification (preferred)

Job description

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at https://www.baptistfirst.org. Highlights: Summary: The RN – Case Management will be utilized as either Utilization Management or as Discharge Planning. The Case Manager tasked with discharge planning shall coordinate care of an assigned caseload of patients through collaboration with physicians, nursing staff, and other health professionals to facilitate efficient utilization of clinical resources, optimal clinical and continuing care, as well as financial outcomes. This individual shall be responsible for providing a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive human service needs through communication and available resources. The Case Manager tasked with utilization management shall work in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payers), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. This individual shall work collaboratively with other Clinical Care staff to ensure patient needs are met and care delivery is coordinated across the continuum. The RN will complete admission, continued stay, and discharge reviews in accordance with federal regulations, Insurance guidelines and Baptist Health's Utilization Management Plan. In addition, the RN is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This position may have additional duties assigned that are within scope of the role.

Education / Experience:

Degree in Nursing, Bachelor's degree preferred. At least 2 years hospital patient care experienced required. Previous experience in home care, reimbursement, or hospital insurance preferred. Previous inpatient hospital case management experience including utilization review (third party payor reimbursement, DRGs), and home care.

License / Certification:

Active RN license required, Case Manager certification preferred

Knowledge, Skills, and Abilities:

• Must possess basic computer skills.
• Strong oral, written and interpersonal skills.
• Ability to work independently with minimal supervision.
• Must be able to function in high-stress environment subject to frequent interruptions and changing priorities.
• Knowledgeable in use of appropriate infection control or isolation techniques when necessary.

Work Conditions/Physical Requirements:

Position requires sitting and mobility with occasional stooping, bending, kneeling, and crouching. There is frequent reaching, use of hands and repetitive action. Requires occasional lifting or carrying up to 20 pounds. There is a continuous need for speaking with clear diction and hearing sensitivity in conversation either by phone or in person. Continuous visual acuity at close and distant range. Inside protected from weather conditions but not necessarily from temperature changes. Minimal noise levels but frequent interruptions. Much exposure to computer work. Occasional exposure to risk of electrical shock. Some exposure to infectious disease while performing job-related tasks. Some exposure to hazardous chemicals. Occasional exposure to radiation. Ability to travel to seminars when required. Weekend and holiday work required. On-Call work required for after hours, weekends, and holidays.

Primary Location:

Baptist Medical Center South Job: RN Case Management RN Case Management Job Type: Regular-Full time Shift: First Shift (United States of America) Baptist Health is recognized by Forbes as one of America’s best employers in the state of Alabama.