RN Case Manager: Patient Care & Care Coordination

Sante Health System, Inc.; Fresno (CA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Competitive pay

Great work environment

Generous benefits

401k retirement plan

Paid time off

Opportunities for advancement

Job summary

Sante Health System in Fresno, CA is seeking a dedicated Registered Nurse (RN) to join as a full-time Case Manager. In this role you will coordinate medical management functions and conduct concurrent reviews, working with insurance providers to verify benefits and medical necessity.

You should have a nursing degree and an active RN license, with at least one year of clinical experience; five years in case management preferred.

Qualifications

• Graduate of an accredited nursing program.
• Minimum of one year of professional nursing experience; five years in case management preferred.
• State RN license required.
• CPR certification preferred.

Responsibilities

• Conduct concurrent reviews of patient documentation in the medical record.
• Perform utilization management based on care protocols and InterQual guidelines.
• Review inpatient records via EPIC and EMR in the computer system.
• Assess physical and psychosocial patient and family needs for case management.
• Work with insurance companies to verify benefits and eligibility.
• Develop discharge plans and authorize home health, SNF, rehab, and equipment as needed.
• Follow discharged patients with case management calls and physician follow-ups.
• Maintain knowledge of Medicare, Medi-Cal and contracted health plans.

Skills

Registered Nurse

Case management

InterQual guidelines

EPIC EMR

Insurance verification

Discharge planning

HIPAA compliance

Education

Graduate of accredited nursing program

Tools

EPIC EMR

Job description

Sante Health System in Fresno, CA is seeking a dedicated Registered Nurse (RN) to join as a full-time Case Manager. In this role you will coordinate medical management functions and conduct concurrent reviews, working with insurance providers to verify benefits and medical necessity.

You should have a nursing degree and an active RN license, with at least one year of clinical experience; five years in case management preferred.