RN Case Manager: Clinical Reimbursement & Discharge

Genesis HealthCare, Inc.; Warwick (RI); On-site; USD 100,000 - 110,000; Full time

Benefits offered by this job

Tuition discounts

Travel discounts

Wireless service

Employee Assistance Program

401K

Paid Time Off

24/7 virtual health care

On-Demand Pay

Job summary

Genesis HealthCare, Inc. in Warwick, RI seeks an Internal Case Manager (RN) to lead clinical reimbursement, utilization management, and discharge planning across care teams, ensuring high-quality patient outcomes while protecting financial integrity.

The role collaborates with physicians, NP, social workers, MDS coordinators, and rehab directors; requires nursing licensure, CCM/related certs preferred, and several years of case management and utilization review experience.

Qualifications

• Must be a graduate of an approved school of nursing with a license as a Registered Nurse or equivalent professional license.
• Bachelor’s degree in nursing preferred. Certified Case Management (CCM) or related clinical certifications are also preferred.
• Five years of recent clinical nursing experience required. Prior experience in utilization review, case management or discharge planning required.
• Prior experience using evidence-based clinical decision support criteria (e.g.Interqual, Milliman)
• Advanced knowledge of third-party reimbursement, insurance coverage and contract requirements.
• Experience in rehabilitation nursing, acute care and/or the insurance field is preferred.
• Two years’ full-time experience in case management, which includes service to short/long-term facility-based residents, is preferred.

Responsibilities

• Utilization & Concurrent Review: Verify, document, and submit complete clinical data to payors from pre-admission through concurrent review (using PointClickCare and NetHealth) to justify medical necessity.
• Payor Negotiations & Authorizations: Negotiate level of care (LOC), length of stay (LOS), daily rates, and service extensions. Secure approvals for procedures, treatments, equipment, and non-formulary medications.
• Interdisciplinary Collaboration: Serve as the clinical reimbursement resource for physicians, nurse practitioners, social workers, MDS coordinators, and rehab directors to align care plans with contract terms.
• Financial Risk & Appeals Management: Monitor cases for service over/under-utilization to prevent claim denials. Assist with clinical appeals and ensure timely delivery of Notices of Non-Coverage.
• Discharge & Transition Planning: Identify risk factors, chronicity, and barriers to discharge early. Partner with network providers and local staff to ensure safe, seamless patient transitions.

Skills

Utilization review

Case management

Discharge planning

Interdisciplinary collaboration

Financial risk management

Third-party reimbursement knowledge

Rehabilitation nursing experience

Education

Bachelor’s degree in nursing

CCM certification (preferred)

Tools

PointClickCare

NetHealth

Job description

Genesis HealthCare, Inc. in Warwick, RI seeks an Internal Case Manager (RN) to lead clinical reimbursement, utilization management, and discharge planning across care teams, ensuring high-quality patient outcomes while protecting financial integrity.

The role collaborates with physicians, NP, social workers, MDS coordinators, and rehab directors; requires nursing licensure, CCM/related certs preferred, and several years of case management and utilization review experience.