RN Case Manager: Care Transitions & Utilization Review

Dilkon Medical Center | Winslow Indian Health Care Career Page; Winslow (AZ); Presencial; USD 65 000 - 90 000; Tempo integral

Resumo da oferta

Winslow Indian Health Care Center in Winslow, AZ is seeking an experienced RN to lead utilization review and case management activities. The role focuses on coordinating transitions in care, validating medical necessity, and ensuring seamless referrals from pre-admission through discharge.

The position emphasizes collaboration with patients, families, and multiple healthcare teams, with attention to confidentiality, regulatory compliance, and continuous process improvement.

Qualificações

• Graduate from an accredited nursing program; Associate degree considered with advanced nursing experience.
• Must be a licensed Registered Nurse in a US state.
• CCMC certification preferred; candidate must sit for CCM exam within 18 months of hire.
• Three years clinical experience with at least one year in utilization management, discharge planning, or case management.

Responsabilidades

• Provide utilization review and case management from pre-admission to post-discharge.
• Coordinate referrals and transitions in care with patients, families, and interdisciplinary teams.
• Determine medical necessity and level of care using CMS criteria.
• Ensure confidentiality and adherence to HIPAA and organizational policies.

Conhecimentos

Utilization review

Case management

Discharge planning

Communication

HIPAA/privacy

Formação académica

Associate degree

Bachelor’s degree preferred

Ferramentas

RPMS

EHR systems (Cerner, Epic)

McKesson

AHCCCS portals

Descrição da oferta de emprego

Winslow Indian Health Care Center in Winslow, AZ is seeking an experienced RN to lead utilization review and case management activities. The role focuses on coordinating transitions in care, validating medical necessity, and ensuring seamless referrals from pre-admission through discharge.

The position emphasizes collaboration with patients, families, and multiple healthcare teams, with attention to confidentiality, regulatory compliance, and continuous process improvement.