RN Case Manager - Post-Acute Care & Compliance

Pruitthealth Corporation; Norcross (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

PruittHealth Corporation in Norcross, GA is seeking an experienced RN Case Manager to ensure continuation of medically necessary services post-acute care and to navigate the continuum of care.

The role requires current GA RN license, at least 3 years of clinical experience, and familiarity with CMS, Medicare/Medicaid guidelines. Home health or skilled nursing background preferred; strong computer and MS Office skills are essential.

Qualifications

• Current GA Registered Nurse license.
• Minimum of 3 years of clinical experience.
• Home Health Care or skilled nursing experience preferred.
• Proficient in computer applications for daily use.
• Microsoft Word, Excel and Outlook required.

Responsibilities

• Understand CMS and Commercial Insurance requirements to ensure regulatory compliance.
• Knowledgeable about medical necessity review guidelines for commercial, Medicare, and Medicaid products.
• Apply insurance criteria and regulations to expedite appropriate use of resources and comply with third-party payer contracts.
• Communicate effectively via phone and email with internal and external customers.
• Maintain strong organization and ability to multi-task to succeed in this role.

Skills

Communication skills

Organizational skills

Multi-tasking

Phone/email communication

Education

RN license GA

Tools

Microsoft Word

Excel

Outlook

Job description

PruittHealth Corporation in Norcross, GA is seeking an experienced RN Case Manager to ensure continuation of medically necessary services post-acute care and to navigate the continuum of care.

The role requires current GA RN license, at least 3 years of clinical experience, and familiarity with CMS, Medicare/Medicaid guidelines. Home health or skilled nursing background preferred; strong computer and MS Office skills are essential.