RN Case Manager - Discharge & Utilization Lead

Waterbury Health; West Side Hill (CT); On-site; USD 85,000 - 105,000; Full time

Job summary

Waterbury Health is seeking a Case Manager to provide clinically-based case management under the Director. Responsibilities include utilization management, transition planning, and collaboration with social workers and the health care team to ensure appropriate resources and reimbursement.

The role requires strong interpersonal, communication, and negotiation skills, with a minimum of 5 years of clinical experience in medical/surgical nursing and CT RN licensure.

Qualifications

• Minimum of 5 years of broad clinical experience, predominately in medical/surgical nursing.
• Licensed as a Registered Nurse in the State of Connecticut.
• BSN preferred or actively pursuing BSN.
• Case management, discharge planning and utilization review experience preferred.

Responsibilities

• Determines medical necessity, appropriateness of admission, continuing stay and level of care using clinical information, criteria and third party information.
• Intervenes when determinations are not aligned and documents in the EMR.
• Collaborates with third party payers to anticipate denials and addresses issues to prevent denials.
• Supports discharge planning in collaboration with the multidisciplinary team and patient/family.
• Communicates with patients/families about reimbursement issues and discharge options.
• Ensures safe and expeditious transitions through patient throughput and care coordination.

Skills

Interpersonal skills

Communication skills

Negotiation

Analytical ability

Independent worker

Time management

Problem solving

Oral and written communication

Team collaboration

Education

RN license CT

BSN preferred

Graduate nursing program

Tools

EMR systems

Clinical software

Job description

Waterbury Health is seeking a Case Manager to provide clinically-based case management under the Director. Responsibilities include utilization management, transition planning, and collaboration with social workers and the health care team to ensure appropriate resources and reimbursement.

The role requires strong interpersonal, communication, and negotiation skills, with a minimum of 5 years of clinical experience in medical/surgical nursing and CT RN licensure.