RN Case Manager: Discharge & Utilization Advocate

Aiken Regional Medical Centers, Inc.; Aiken (SC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Sign On Bonus

Unlimited Employee Referral Bonus

Competitive Pay & PTO

Medical, Dental, Vision

Tuition/Certification Reimbursement

401(K) with company match

Job summary

Aiken Regional Medical Centers, located in Aiken, South Carolina, is a 273-bed acute care facility offering comprehensive healthcare services since 1917. We are seeking a Case Manager (RN) for a full-time role to manage admission, concurrent, and retrospective reviews, collaborating with payers to reduce denials and optimize patient flow.

The Case Manager will work with the floor SW/DCP and interdisciplinary teams to ensure timely transitions, appropriate utilization, and effective discharge

Qualifications

• Diploma or associate degree from an accredited Registered Nursing program; BSN preferred.
• Minimum of 3 years experience in acute-care hospital or related setting; prior utilization review or case management experience.
• SC RN license or compact state license.

Responsibilities

• Performs chart reviews (admission, concurrent and retrospective) to certify appropriateness of admission and continued stay; reduce denial risks.
• Follows processes for management of denied cases and refers for Peer to Peer or VH appeal.
• Monitors patients for progression of care and discharge readiness; conducts discharge planning as needed.
• Educates medical staff on utilization of hospital days and resources; collaborates to minimize delays.
• Collaborates with Medical staff and departments to develop clinical practice guidelines for patient groups.

Skills

Case Management

Interdisciplinary Collaboration

Discharge Planning

Payer Communication

Education

Diploma or Associates RN program

BSN preferred

Tools

Computer skills

Job description

Aiken Regional Medical Centers, located in Aiken, South Carolina, is a 273-bed acute care facility offering comprehensive healthcare services since 1917. We are seeking a Case Manager (RN) for a full-time role to manage admission, concurrent, and retrospective reviews, collaborating with payers to reduce denials and optimize patient flow.

The Case Manager will work with the floor SW/DCP and interdisciplinary teams to ensure timely transitions, appropriate utilization, and effective discharge