RN Case Manager

Ashtabula Regional Medical Center; Ashtabula (OH); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive salary package

Medical, dental, vision, and life ins.

Paid Time Off

Tuition Reimbursement

Short-Term & Long-Term Disability

Paid Maternity Leave

Employee Wellness Plan

403(b) and Roth Retirement Plan

PSLF program eligibility

Job summary

Ashtabula Regional Medical Center is seeking a Nurse Case Manager to support the physician and interdisciplinary team in coordinating utilization management and discharge planning across the patient care continuum.

The role focuses on enhancing clinical outcomes and patient satisfaction while managing care costs, with required Ohio RN licensure and preferred CCM certification.

Qualifications

• Degree in nursing; RN license in Ohio.
• CCM certification preferred.
• Minimum 1 year managed care experience preferred; 3–5 years acute/medical nursing experience.

Responsibilities

• Coordinate utilization management, care facilitation, and discharge planning.
• Collaborate with hospitalists and other disciplines to impact length of stay and case mix.
• Coordinate pre-certification and payor authorization processes including denials and appeals.
• Support accurate clinical documentation and regulatory compliance.

Skills

Data entry

Interdisciplinary communication

Physician liaison

Nursing care

Education

Nursing degree (RN)

BSN preferred

Tools

Managed care system

Job description

General Summary

Under the direction of the Director of Care Management, this position supports the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. This position is accountable for designed patient caseload and plans effectively in order to meet patients' needs, manage the length of stay, and promotes efficient utilization of resources. Specific functions within this role include:

• Collaborate with Hospitalists and other disciplines coordinating care to impact length of stay and case mix.
• Manage discharge planning upon admission to develop a safe and appropriate transition to the next level of care.
• Coordinating communication with physicians.
• Understands clinical documentation efforts and supports accurate documentation.
• Understands and identifies process improvement methodologies and evaluating outcomes of care.
• Facilitation of pre-certification and payor authorization processes including denials and appeals.
• Demonstrates compliance with regulatory requirements.

Education, Knowledge, Skills And Abilities

Degree in nursing required, BSN preferred. Required professional skills include data entry into and retrieval from a managed care information system, and ability to effectively interface with physicians.

Required Length And Type Of Experience

Minimum of one year experience in a managed care setting preferred, and a minimum of three to five years medical nursing, surgical nursing and/or nursing in the acute care setting.

Required Licensure Or Certification

Current State of Ohio nursing license. Certification in Case Management (CCM) preferred.

Required Physical And Environmental Demands

Work and move among all acute care nursing units. Manual dexterity to operate personal computers and standard office machines. Flexible work hours required throughout the year. General office working conditions

Benefits

• Competitive salary package
• Extensive benefit package including medical, dental, vision, and life insurance (Benefits on Day 1!)
• Accident & critical illness insurance
• Tuition Reimbursement
• Short-Term & Long-Term Disability Insurance
• Paid Maternity Leave
• Employee Assistance Program
• Paid Time Off
• Employee Wellness Plan that pays you for being healthy
• 403(b) and Roth Retirement Plan with company matching
• We are a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program which allows you to receive forgiveness of the remaining balance of your Direct Loans after you have made 120 qualifying monthly payments while working full-time for a qualifying employer