RN CASE MANAGER

Care New England; Warwick (RI); On-site; USD 90,000 - 120,000; Full time

Job summary

Care New England is seeking a Registered Nurse to analyze medical records for utilization, determine the appropriate level of care, and support resource management to ensure high-quality patient care across hospital services.

The role includes chart reviews for medical necessity and quality of care, coordinating with discharge planning, communicating with patients and families about hospital stays, and collaborating with departments to ensure accurate payment and bed utilization.

Qualifications

• Bachelor’s Degree in Nursing is required.
• RN license is required.

Responsibilities

• Analyze patient’s medical record for proper utilization or resources (beds and services) and accurate payment.
• Develop the Hospital data base for case management and severity implications.
• Analyze patient’s charts for quality of services rendered and intervene to assure the delivery of quality care.
• Communicate to patient and/or patient’s family as necessary regarding the medical necessity of hospital stay.
• Communicate to appropriate departments to accurately determine level of care at discharge as well as participate in discharge planning.
• Performs all other related duties as assigned.

Education

Bachelor’s Degree in Nursing

RN license

Job description

Job Summary

Responsible for analyzing medical records for the preparation of attestments used in billing and responsible for determining the appropriate level of care, quality care delivered and resource management.

Duties & Responsibilities

• Analyze patient’s medical record for proper utilization or resources(beds and services) and accurate payment.
• Develop the Hospital data base for case management and severity implications.
• Analyze patient’s charts for quality of services rendered and intervene to assure the delivery of quality care.
• Communicate to patient and/or patient’s family as necessary regarding the medical necessity of hospital stay.
• Communicate to appropriate departments to accurately determine level of care at discharge as well as participate in discharge planning.
• Performs all other related duties as assigned.

Requirements

• Bachelor’s Degree in Nursing and a minimum of five year’s job-related experience or equivalent is required.
• An RN license is also required.

About Us

Care New England Health System (CNE)and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.

EEO Statements

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job‑specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case‑by‑case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.