RN Case Manager: Post-Acute Care & Insurance Compliance

PruittHealth; Norcross (GA); On-site; USD 65,000 - 90,000; Full time

Job summary

PruittHealth in Norcross, GA is seeking an RN Case Manager to ensure continuation of medically necessary services for post-acute patients. The role requires GA licensure and at least 3 years of clinical experience in home health or skilled nursing.

You will navigate CMS and commercial insurance requirements, assist with care coordination, and communicate with patients, families, and providers by phone and email. Strong organization and multitasking are essential in this fast-paced environment.

Qualifications

• Currently licensed Registered Nurse in GA.
• A minimum of 3-years of clinical experience is required.
• Home Health Care and/or skilled nursing industry experience highly preferred.
• Must be proficient in the use of computer applications for daily use.
• Highly proficient in Microsoft Word, Intermediate Excel and Outlook required.

Responsibilities

• Understands CMS and Commercial Insurance requirements to ensure regulatory compliance.
• Knowledge of medical necessity guidelines for commercial, Medicare, and Medicaid products.
• Uses insurance criteria and regulations to expedite appropriate use of resources and ensure payer contract compliance.
• Communicates effectively via phone and email with internal and external customers.
• Demonstrates strong organizational skills and the ability to multitask in a fast-paced environment.

Skills

Communication skills

Organization

Multitasking

Phone & Email communication

Tools

Microsoft Word

Excel

Outlook

Job description

PruittHealth in Norcross, GA is seeking an RN Case Manager to ensure continuation of medically necessary services for post-acute patients. The role requires GA licensure and at least 3 years of clinical experience in home health or skilled nursing.

You will navigate CMS and commercial insurance requirements, assist with care coordination, and communicate with patients, families, and providers by phone and email. Strong organization and multitasking are essential in this fast-paced environment.