RN Case Manager

Kootenai Hospital; Coeur d'Alene, Northern (ID, KY); Hybrid; USD 75,000 - 105,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

Tuition assistance

Retirement plan

Shift differentials

Wellness program

PerkSpot discounts

Referral bonus

Job summary

Kootenai Health in Coeur d'Alene, ID is seeking an RN Case Manager to coordinate hospital transitions to the next level of care, partnering with medical staff and care coordinators to ensure timely, safe discharges.

You will participate in discharge planning, utilization management, and collaboration with CMS standards, emphasizing communication and independent decision-making.

Qualifications

• State of Idaho RN or temporary licensure accepted, documented by licensure.
• RN with minimum 3 years of patient-facing experience; ADN or diploma required, BSN or higher preferred.
• RNs with less than 3 years as ADN must enroll in baccalaureate nursing program within 1 year; BSN completion within 3 years.
• Minimum 3 years clinical practice experience required.
• CCM/ACMA/CPUR/CMAC certifications preferred.
• Proficient with standard software (spreadsheets, word processing). InterQual experience preferred.
• Knowledge of healthcare law/regulations related to acute and post-acute care preferred.

Responsibilities

• Participates in utilization management, discharge planning, and patient throughput.
• Evaluates medical necessity during hospitalization.
• Manages payer relations to optimize reimbursement and outcomes.
• Reviews documentation for quality and clinical validation.
• Ensures CMS discharge standards are achieved.
• Collaborates with medical staff and care teams for safe transitions.

Skills

Communication skills

Organizational skills

Interpersonal skills

Independent work

Time management

Education

ADN or Diploma in Nursing

BSN preferred

CCM certification preferred

Tools

InterQual

Job description

• Department Transitional Care Services - Care Management
• Schedule/Shift/Hours PRN - (As Needed) - Days

Position SummaryThe RN Case Manager functions as a resource and advocate on behalf of the patient and family while assisting in the navigation of the health care delivery continuum by operationalizing multiple processes. Coordinates hospital transitions to the next level of care, including, but not limited to, medical community partners, Kootenai Care Network, and ambulatory clinic care coordinators.

Responsibilities

• Participates in utilization management, discharge planning, patient throughput, and evaluates the appropriate use of hospital resources by ensuring that patients meet medical necessity during their hospitalization
• Utilizes the organizational approved references and software programs to assess medical necessity
• Responsible for managing payer relations and requirements to achieve optimum reimbursement and patient outcomes
• Reviews documentation for quality assurance and clinical validation
• Ensures CMS discharge standards are achieved
• Provides case management in collaboration with the medical staff, nursing, and ancillary departments throughout the hospital to ensure a safe, timely, transition to the appropriate level of care
• Familiar with standard concepts, practices, and procedures within the field
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• State of Idaho Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with Idaho
• Licensed RN with a minimum 3 years’ patient-facing RN experience at time of hire, ADN or diploma required; BSN or higher preferred.
• Licensed RN's with less than 3 years’ patient-facing RN experience as an ADN at time of hire are required to be enrolled in a baccalaureate (or higher) degree program in nursing within 1 year of employment, with BSN completion within 3 years of hire
• Minimum 3 years clinical practice experience required
• Current Certified Case Manager (CCM) certification, American Case Management (ACMA) certification, Certified Professional Utilization Review (CPUR) or Case Management Administration Certification (CMAC) preferred
• Excellent communication, organizational and interpersonal skills. Ability to work independently and manage time and decisions
• Proficiency with standard software applications including spreadsheets and word processing required. Experience using Interqual preferred
• Knowledge of healthcare law and regulations related to acute care and the immediate post-acute continuum preferred

Working Conditions

• Must be able to maintain a standing and/or sitting position
• Typical equipment used in an office job
• Repetitive movements

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Comprehensive medical coverage, including fully employer-paid options for eligible full-time employees, plus affordable plans for part-time staff.Benefits begin on the 1st of the month following 30 days of employment.
• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees
• Tuition assistance after 90 days to support your professional growth
• Retirement plans with pre-tax and Roth options and employer matching from 3%-6%
• Competitive pay, plus night, weekend, and PRN shift differentials
• Award-winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps
• PerkSpot discountsproviding access to thousands of exclusive deals in over 25 categories
• And an employee referral bonus program

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.

Why I love my job as a Nurse at Kootenai Health

A variety of medical, dental, and vision insurance plans are available to both full and part-time employees, with some available at no cost to the employee. In addition, benefit-eligible employees also gain access to the following:

• Tuition assistance and career development programs
• Robust Retirement Plan
• Night, weekend and PRN shift differentials

This is a snapshot of your potential career path highlights the series of job positions that help you progress towards your goals and objectives. Ultimately, your career path depends on your career values and personal goals.

Success Profile

What makes a successful nurse at Kootenai Health?