RN Case Manager

Prime Healthcare; Gadsden (AL); On-site; USD 65,000 - 90,000; Full time

Job summary

Prime Healthcare’s Riverview Regional Medical Center in Gadsden, AL is seeking an experienced RN Case Manager to oversee patient care from admission through discharge. This role emphasizes care coordination, discharge planning, and utilization review to ensure high-quality, cost-effective outcomes.

Qualified candidates will hold a valid State RN license, a related bachelor's degree, and CCM certification (or plan to obtain within 6 months).

Qualifications

• Valid State RN License.
• BSW or related bachelor degree.
• Current CCM or obtained within 6 months of hire.
• Experience with basic to intermediate computer skills.
• Behavioral Violence Prevention Training within 3 months of hire and maintain current.

Responsibilities

• Patient assessment upon admission and throughout stay.
• Care coordination and development of individualized care plans with the healthcare team.
• Discharge planning and referrals to rehab, home health, or long-term care as needed.
• Utilization review to ensure appropriate care and avoid unnecessary treatments or extended stays.
• Patient and family education about care plans and post-discharge instructions.
• Advocacy for patient needs and preferences, aligning with goals and values.

Skills

Care coordination

Discharge planning

Communication

Team collaboration

Education

Bachelor degree in related field

CCM certification

Tools

Electronic Health Records

Job description

Overview

Shift’s Available: Day

Employment Type: Per Diem/PRN

Hours: 8-hour shift: weekends only

Location: Riverview RegionalMedical Center – Gadsden, AL

We are seeking an RN Case Manager, also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager. An RN Case Manager will oversee 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 also conduct discharge planning, utilization review, and helping patients navigate insurance and healthcare systems.

Responsibilities

Essential Duties and Responsibilities (includes, but not limited to):

• 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

Qualifications

Before we go any further, we do have some deal-breakers. You must have:

• Valid State RN License
• BSW or other Bachelor degree in a related field
• Current CCM or obtained within 6 months of hire
• Experience and knowledge in basic to intermediate computer skills
• Behavioral Violence Prevention Training within 3 months of hire and maintain current

Additional Qualifications That Are a Plus:

• Minimum 5 years of acute care experience
• At least one-year experience in case management, discharge planning or management
• Current BLS (AHA) certificate
• Knowledge of Milliman Criteria and InterQual Criteria

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/

Pay Transparency

BCBS of Alabama interqual Jiva experience required

Employment Status

Per Diem

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. 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