RN Case Manager

CP01 Carilion Medical Center; Roanoke (VA); On-site; USD 76,689 - 115,044; Full time

Benefits offered by this job

Health, dental, vision benefits

Pension plan (employer‑funded)

403(b) plan

Paid time off from day one

Onsite fitness & wellness facilities

Wellness app access

Childcare discounts

Continued education opportunities

Job summary

Carilion Clinic in Roanoke is seeking a RN Case Manager to provide comprehensive case management for patient populations, directing referrals and coordinating discharge planning. The role emphasizes collaboration with interdisciplinary teams to optimize clinical outcomes and resource use.

The position requires Virginia RN licensure, a Bachelor's degree, and strong knowledge of regulatory requirements, InterQual, and EMR systems. Sign‑on bonus and relocation assistance are available.

Qualifications

• RN with Virginia licensure required.
• Bachelor's degree required; five years RN experience may be considered in lieu of a bachelor’s.
• Three years of recent clinical experience with discharge planning and utilization management.
• AHA BLS‑HCP certification required within six months of hire.
• Proficient with InterQual, predictive analytics, and EMR systems.

Responsibilities

• Provide case management for assigned patient populations.
• Promote cost‑effective care by coordinating services and avoiding fragmentation.
• Conduct patient needs assessments and facilitate referrals to post‑acute resources.
• Collaborate with interdisciplinary teams to advance care plans and discharge planning.
• Maintain documentation reflecting patient status and regulatory compliance.
• Coordinate care within the case‑managed population and liaison with social work and UR.

Skills

Clinical case management

InterQual knowledge

Discharge planning

Communication skills

Team collaboration

Regulatory knowledge

Electronic Medical Records

Education

Bachelor's degree

RN licensure (Virginia)

Tools

InterQual

EMR systems

Job description

Job Overview

Employment Status: Full Time. Shift: Day/Evening (United States of America). Facility: 1906 Belleview Ave SE – Roanoke. Requisition Number: R151592. RN Case Manager (Open). How You’ll Help Transform Healthcare: Full time – Monday to Friday, 8:00 a.m. to 4:30 p.m. Sign‑on bonus and relocation assistance available.

Responsibilities

• Provide case management for assigned patient populations, utilizing clinical expertise, communication, and problem‑solving skills to achieve optimal clinical and resource outcomes.
• Promote cost‑effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization.
• Conduct patient needs assessments upon admission and at regular intervals; facilitate referrals and linkages to health, wellness, and post‑acute care resources.
• Collaborate with interdisciplinary teams to progress the plan of care and discharge plan; promote appropriate length of stay and resource management.
• Comply with all federal and state regulations surrounding the discharge process; maintain documentation that reflects patient condition, co‑morbidities, treatment, and procedures for admission status and DRG assignment.
• Maintain regular contact with assigned Utilization Review Nurse throughout the day; use InterQual software to support accurate patient status and medical necessity.
• Coordinate care and services within the case‑managed population; liaise with social work, utilization review, and other disciplines.
• Facilitate timely and appropriate discharges; communicate with patients/families regarding financial implications and discharge plans.
• Participate in interdisciplinary team meetings, unit‑based IDR huddles, and daily case reviews; provide verbal and chart feedback on patient progress.
• Coordinate referrals for post‑acute services (home health, hospice, durable medical equipment) and high‑cost medication assistance.
• Assist in transitions of care, including acute‑to‑acute transfers and inmate transitions; advocate for patients and families throughout the episode of care.
• Participate in departmental and system performance‑improvement initiatives; analyze data and evaluate case‑management impact.

Daily Tasks / Expectations

• Participate in unit‑based IDR morning and afternoon huddles.
• Coordinate referrals for DME, HH, and Hospice.
• Use predictive analytic software (e.g., JVION) to assess patient data.
• Complete face‑to‑face patient assessments.
• Communicate with assigned UR nurse and SW partner.
• Reassess patients and document status of referrals and barriers.
• Aid in delivery of regulatory letters (IM, HINN).
• Integrate InterQual information during unit huddles.
• Provide medication assistance and investigate authorization needs.
• Communicate post‑acute care needs of inmates during transitions back to jail.
• Assist in acute‑to‑acute and transitions of care.
• Maintain awareness of unit‑based patient needs.
• Provide hand‑off communication of unit needs to peers during weekday/weekend transitions.

Qualifications

• Registered Nurse with current licensure in Virginia.
• Bachelor’s degree required; five years of RN experience may be considered in lieu of a bachelor’s.
• Three years of recent clinical experience with direct patient‑care management, discharge planning, and utilization management.
• Slight supervisory or leadership experience preferred.
• AHA BLS‑HCP certification required within six months of hire.
• Demonstrated knowledge of regulatory requirements, systems, and community resources.
• Computer literacy and proficiency with InterQual, predictive analytics, and electronic medical records.
• Strong interpersonal, written, and verbal communication skills.
• Team player, customer‑focused, innovative, flexible, and able to resolve complaints.

Compensation Range

$76,689.60 – $115,044.80, based on qualifications, credentials, education, and experience. Benefits and pension plan information not included.

Benefits

• Comprehensive medical, dental, and vision benefits.
• Employer‑funded pension plan (vested after five years) and voluntary 403(b) plan.
• Paid time off accrued from day one.
• Onsite fitness studios and wellness center discounts.
• Health and wellness app access.
• Childcare discounts.
• Continued education and training opportunities.

Equal Opportunity Employment

Carilion Clinic is an Equal Opportunity Employer. We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status. Carilion is a drug‑free workplace. For more information on E‑Verify, visit https://www.carilionclinic.org/eoe-e-verify-and-right-work-policies.