RN Case Manager: Discharge Planning & Payer Review

US HealthCare Careers; Rumford (ME); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a Care Manager to oversee discharge planning and utilization review for patients with Medicare, Medicaid, and private insurance. The role involves collaboration with healthcare professionals, assessing patient needs, and ensuring compliance with insurance criteria. Candidates must hold an RN license and have relevant experience in a hospital setting.

Qualifications

• Graduate of an accredited school of nursing.
• Up to six months of Registered Nurse experience.
• Current American Heart Association Healthcare Provider BLS certification required.

Responsibilities

• Assess, plan, implement, and evaluate patients' discharge needs.
• Coordinate discharge planning with various stakeholders.
• Conduct utilization review pertaining to insurance coverage.

Skills

Discharge planning

Utilization review

Knowledge of Medicare and Medicaid

Community resources knowledge

Education

Registered Nurse license

BSN or equivalent experience

Job description

The Care Manager assesses, plans, implements, and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO, or private insurance to cover their stay at various units.

• Discharge planning is coordinated with physicians, nursing, patients, and significant others who have an ongoing caring relationship with the patient.
• Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

Requirements

• Graduate of an accredited school of nursing with up to six (6) months of Registered Nurse experience.
• Current RN license within the state of practice.
• Current American Heart Association Healthcare Provider BLS required. BSN or equivalent experience required.
• Knowledgeable of criteria for Medicare, Medicaid, HMO, and private insurance coverage.
• Maintains current knowledge of resources available within the community, and maintains supply of resource materials to be distributed to patients when and how obtain other resources as needed.

Gretchen Sheppard ~ US HealthCare Careers ~ [e-mail] ~ 408-686-9450