RN Case Manager

Pruitthealth Corporation; Norcross (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

PruittHealth Corporation in Norcross, GA is seeking an experienced RN Case Manager to ensure continuation of medically necessary services post-acute care and to navigate the continuum of care.

The role requires current GA RN license, at least 3 years of clinical experience, and familiarity with CMS, Medicare/Medicaid guidelines. Home health or skilled nursing background preferred; strong computer and MS Office skills are essential.

Qualifications

• Current GA Registered Nurse license.
• Minimum of 3 years of clinical experience.
• Home Health Care or skilled nursing experience preferred.
• Proficient in computer applications for daily use.
• Microsoft Word, Excel and Outlook required.

Responsibilities

• Understand CMS and Commercial Insurance requirements to ensure regulatory compliance.
• Knowledgeable about medical necessity review guidelines for commercial, Medicare, and Medicaid products.
• Apply insurance criteria and regulations to expedite appropriate use of resources and comply with third-party payer contracts.
• Communicate effectively via phone and email with internal and external customers.
• Maintain strong organization and ability to multi-task to succeed in this role.

Skills

Communication skills

Organizational skills

Multi-tasking

Phone/email communication

Education

RN license GA

Tools

Microsoft Word

Excel

Outlook

Job description

Job Description - RN Case Manager (2612004)

RN Case Manager - 2612004

Description

POSITION SUMMARY

Ensures the continuation of medically necessary services to our patients post -acute care. Demonstrates understanding of post-acute services and case management as it relates to the continuum of care.

ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES

• Demonstrates the ability to understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards.
• Must be knowledgeable of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products.
• Uses knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts.
• Demonstrates the ability to communicate effectively via phone and email with our internal and external customers.
• Strong organization and ability to multi task is essential to success in this role.

LICENSURE, CERTIFICATION, EXPERIENCE AND EDUCATION REQUIREMENTS

• Currently licensed Registered Nurse in the state of GA.
• A minimum of 3-years of clinical experience is required.
• Home Health Care and or skilled nursing industry experience highly preferred.
• Must be proficient in the use of computer applications for daily use.
• Highly proficient in Microsoft Word, Intermediate Excel and Outlook required

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

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