RN-Case Manager

Baptist Memorial Health Care Corporation; Southaven (MS); On-site; USD 65,000 - 80,000; Full time

Job summary

Baptist Memorial Health Care Corporation in Mississippi seeks an RN Case Manager to oversee patient care transitions, conduct utilization reviews, and collaborate with care teams to optimize resource use and align with payer requirements.

The role focuses on discharge planning, readmission reduction, and effective payer communications, relying on strong clinical judgment and regulatory knowledge.

Qualifications

• RN with at least one year of clinical experience.
• BSN or MSN preferred for advancement.
• Certified Case Manager training encouraged.

Responsibilities

• Perform Utilization Review activities.
• Coordinate discharge planning and transition of care.
• Participate in Readmission Reduction initiatives.
• Communicate with payers to reduce denials and improve approvals.
• Complete assigned goals and document outcomes.

Skills

Critical thinking

Communication

Organization

Interpersonal skills

Computer skills

Problem solving

Regulatory knowledge

Education

Diploma or Associate Degree in Nursing

BSN or MSN (preferred)

Tools

N/A

Job description

Overview

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 one (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

• RN

Minimum Required

• RN

Preferred/Desired

• RN;CCM;ACM