RN Case Manager

Prime Healthcare; Gadsden, Northern (AL, KY); Hybrid; USD 70,000 - 90,000; Part time

Job summary

Prime Healthcare's Riverview Regional Medical Center in Gadsden, AL is seeking an RN Case Manager to oversee patient care from admission to discharge. You will coordinate with physicians, nurses, social workers, and other providers to ensure quality and cost-effective outcomes, with weekend shifts on a 8-hour schedule.

Required are a valid RN license, a related Bachelor's degree, and CCM certification (or within 6 months).

Qualifications

• Valid State RN License
• Bachelor's degree in a related field
• CCM or to be obtained within 6 months of hire
• Basic computer skills
• Behavioral Violence Prevention Training within 3 months of hire and maintained

Responsibilities

• Patient Assessment: evaluate patients’ medical, psychosocial, and discharge needs
• Care Coordination: develop and implement individualized care plans with the team
• Discharge Planning: coordinate safe discharge plans and referrals
• Utilization Review: monitor hospital resource use to ensure appropriate care
• Patient and Family Education: explain care plans and post-discharge instructions
• Advocacy: represent patient needs and preferences in care decisions

Education

Bachelor's degree in a related field

CCM certification (within 6 months of hire)

Tools

Milliman Criteria

InterQual Criteria

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/

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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, and local laws. The 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