RN Case Manager: Discharge & Utilization Lead

Aiken Regional Medical Centers; Aiken (SC); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Sign-On Bonuses

Unlimited Employee Referral Bonus

Generous Paid Time Off

Medical, Dental, Vision plans

Job summary

Aiken Regional Medical Centers in Aiken, SC seeks a Case Manager (RN) for full-time day shift to oversee admission, concurrent and retrospective reviews, and discharge planning, coordinating with payers and the interdisciplinary team to optimize care and resource use.

Responsibilities include reducing avoidable days, ensuring appropriate documentation, collaborating with SW/DCP, and guiding transitions of care while maintaining regulatory compliance and patient safety.

Qualifications

• Knowledge of private insurance and Medicare criteria for hospitalization.
• Understanding of healthcare financial systems and benchmarking practices.
• Experience facilitating change through interdisciplinary collaboration.
• Proficient computer skills and chart reviews.

Responsibilities

• Perform admission, concurrent and retrospective chart reviews for payer sources.
• Follows processes for denied cases and referrals to VH appeal.
• Monitor patients for progression of care and discharge readiness.
• Collaborate with SW/DCP and Interdisciplinary team to anticipate discharges and minimize delays.

Skills

Insurance knowledge

Medicare criteria

Healthcare finance systems

Benchmarking practices

Interdisciplinary collaboration

Computer skills

Education

Diploma or Associate Degree in Nursing

BSN preferred

Job description

Aiken Regional Medical Centers in Aiken, SC seeks a Case Manager (RN) for full-time day shift to oversee admission, concurrent and retrospective reviews, and discharge planning, coordinating with payers and the interdisciplinary team to optimize care and resource use.

Responsibilities include reducing avoidable days, ensuring appropriate documentation, collaborating with SW/DCP, and guiding transitions of care while maintaining regulatory compliance and patient safety.