RN-Case Manager

Baptist Memorial Health Care Corporation; Kosciusko (MS); On-site; USD 60,000 - 80,000; Full time

Job summary

Baptist Memorial Health Care Corporation is seeking an RN with case management responsibilities to oversee patient care transitions and ensure appropriate utilization of resources. The role emphasizes early assessment, discharge planning, and coordination with payers to reduce unnecessary denials.

The ideal candidate has 1 year of clinical RN experience with preferred emphasis in case management. Diploma/Associate degree required, BSN/MSN preferred, and CCM/ ACM certification may be considered.

Qualifications

• RN with at least 1 year of clinical experience.
• Diploma or Associate Degree in Nursing required.
• BSN/MSN preferred for advancement.

Responsibilities

• Manages care for a specific population and facilitates safe transitions across the continuum of care.
• Supports utilization review, discharge planning, and readmission reduction efforts.
• Maintains payer communications and supports denial reduction strategies.
• Completes assigned goals and adheres to regulatory requirements.

Skills

Critical thinking

Communication

Organization

Interpersonal skills

Computer skills

Problem solving

Regulatory knowledge

Education

Diploma or Associate Degree in Nursing

BSN or MSN (preferred)

Job description

Job Summary

Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.

Responsibilities

• Utilization Review
• Discharge planning
• Readmission Reduction Participation
• Payer Communication and denial reduction
• Completes assigned goals

Specifications

Experience

Minimum Required

• RN with at least (1) year of clinical experience

Preferred/ Desired

• RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting

Education

Minimum Required

• Diploma or Associate Degree in Nursing

Preferred/ Desired

• BSN or MSN

Training

Minimum Required

Preferred/Desired

• Certified Case Manager

Special Skills

Minimum Required

Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.

Preferred/Desired

Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.

Licensure

Minimum Required

RN

Preferred/Desired

RN; CCM; ACM