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RN - Case Management - Full Time - Days (UTICA, NY)
$40.19 - $50.61/Hourly
UTICA, NY 5 days ago

Job Summary

Reports to and is under direct supervision of Case Management Department. Provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. Promotes continuity of care and cost effectiveness through the integrating and functions of case management.

Core Job Responsibilities
  • Coordinates discharge planning to assure that the patient progresses through the continuum of care and is discharged to the least restrictive environment.
  • Coordinate the hospital activities concerned with case management and discharge planning.
  • Ensure compliance with quality patient care and regulatory compliance.
Education/Experience Requirements

Required: 

  • Minimum of two (2) years utilization review/case management experience or social work experience.

Preferred: 

  • Associate degree in healthcare related filed.
  • Bachelor’s degree is preferred.
  • Licensed professional nurse may be considered.
  • Bachelors or Masters Degree in related healthcare field (such as respiratory therapy or social work) may be considered.
Licensure/Certification Requirements

Required: 

  • Maintain current professional licensure in nursing or professional filed of certification.

Preferred: 

  • Appropriate certification in the case management preferred (e.g. Commission for Case Management Certification (CCMC) or Association of Rehabilitation Nurses).
Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.

Successful candidates might be required to undergo a background verification with an external vendor.

Job Details


Req Id  97256 
Department  CASE MGMT 
Shift Days
Shift Hours Worked  7.50
FTE 0.94 
Work Schedule  NYSNA - 7.5 HR
Employee Status A1 - Full-Time 
Union 2004 - NYSNA
Pay Range $40.19 - $50.61/Hourly

permanent
RN Case Manager, Home Health
$77,200 - $106,200 per year
Wilkesboro, NC 6 days ago
Become a part of our caring community and help us put health first
 Make a meaningful impact every day as a CenterWell Home Health nurse. You’ll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you’ll develop and manage care plans that support recovery and help patients get back to the life they love.

Area Coverage - Yadkin & Surry, Elkin, Jonesville, State road , Thurmond

We are offering a $10,000 sign on bonus for our full-time registered nurse case manager position.

As a Home Health RN Case Manager, you will:

  • Provide admission, case management, and follow-up skilled nursing visits for home health patients.

  • Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.

  • Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment.  Provide hands-on care, management, and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision.  Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.

  • Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides, and external providers).

  • Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis. 

  • Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems. 

  • Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflects current plan of care.  Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.

  • Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.

  • Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes.  Prepare visit/shift reports, updates/summarizes patient records and confers with other health care disciplines in providing optimum patient care


Use your skills to make an impact
 

Required Experience/Skills:

  • Diploma, Associate, or Bachelor Degree in Nursing

  • A minimum of one year of nursing experience preferred

  • Strong med surg, ICU, ER, acute experience

  • Home Health experience is a plus

  • Current and unrestricted Registered Nurse licensure

  • Current CPR certification

  • Strong organizational and communication skills

  • A valid driver’s license, auto insurance, and reliable transportation are required.


Pay Range
•    $49.00 - $69.00 pay per visit/unit
•    $77,200 - $106,200 per year base pay

 

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


 

$77,200 - $106,200 per year


 

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
 About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

permanent
RN Inpatient Case Mgr - Discharge Planner - Relocation Offered!
USD $89,065.00/Yr. - USD $162,801.00/Yr
Washington, DC 4 days ago
About this Job:

General Summary of Position


Serves as a member of the Case Management Team and applies RN clinical expertise and medical appropriateness to care coordination and discharge planning. Facilitates the delivery of quality cost effective patient-centered care from pre-admission through post-discharge timeframe. Ensures the care is designed to meet individualized patient outcomes. Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal clinical and resource outcomes for the acute and post-hospital phases of care.

 

Primary Duties and Responsibilities

 

  • Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
  • Collaborates with the multidisciplinary health care team to develop and coordinate the plan of care.
  • Communicates with patient family and/or significant other health care team external case manager community resources and facility to address appropriate issues and patient/family goals.
  • Demonstrates the ability to develop a plan of care that addresses needs across the continuum; have an intervention for problems identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives.
  • Evaluates and documents the patient's response to the plan of care and achievement of outcomes. Makes recommendations for modifications to the plan of care as indicated. Adheres to all policies and procedures regarding documentation and confidentiality of information.
  • Maintains knowledge of regulatory agencies' requirements necessary criteria for admission to various care settings and Medicare's/Medicaid's reimbursement methods for different levels of care.
  • Manages a caseload of patients. Identifies essential resources needed to implement the plan of care.
  • Manages own professional growth in the area of managed care care management other health care financial trends clinical practice and research.
  • Manages patient care according to multidisciplinary plan of care and/or managed care contracts by directing decision making and identifying and managing barriers that impact on patient care outcomes.
  • Participates in Performance and Service Improvement teams. Assists in program evaluation through customer service surveys LOS data analysis charge/discharge data comparison to state averages and best practice/benchmark data.
  • Performs a comprehensive assessment in collaboration with interdisciplinary team to identify patient-specific problems and needs related to diagnosis treatment including psychosocial and financial concerns as well as medical.

Minimal Qualifications
Education

  • Associate's degree in Nursing (ADN) required
  • Bachelor's degree in Nursing (BSN) preferred

Experience

  • Minimum of 2 years clinical experience in an acute care hospital setting required
  • 1-2 years case management experience preferred

Licenses and Certifications

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia or Maryland depending on work location required
  • CCM - Certified Case Manager preferred

Knowledge Skills and Abilities

  • Ability to use computer to enter and retrieve data.
  • Working knowledge of Microsoft Word Excel and PowerPoint applications.
  • Effective verbal and written communication skills.
  • Must be able to run and analyze departmental productivity reports.
  • Excellent interpersonal skills required.
This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.
permanent
Registered Nurse RN Case Management PRN
Salary not disclosed
Brownsville, TX 5 days ago
Introduction

Are you looking for a place to deliver excellent care patients deserve? At Valley Regional Medical Center we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Case Management and access programs to assist with every stage of your career.

Benefits

Valley Regional Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
  • Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  • Free counseling services and resources for emotional, physical and financial wellbeing
  • 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  • Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  • Family support through fertility and family building benefits with Progyny and adoption assistance.
  • Referral services for child, elder and pet care, home and auto repair, event planning and more
  • Consumer discounts through Abenity and Consumer Discounts
  • Retirement readiness, rollover assistance services and preferred banking partnerships
  • Education assistance (tuition, student loan, certification support, dependent scholarships)
  • Colleague recognition program
  • Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  • Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Are you a continuous learner? With more than 94,000 nurses throughout HCA Healthcare, we are one of the largest employers of nurses in the United States. Education is key to excellence! As a majority owner of Galen College of Nursing, which joins Research College of Nursing and Mercy School of Nursing as educational facilities within the HCA Healthcare family, we make it easier and more affordable to gain certifications and job skills. Apply today for our Registered Nurse RN Case Management opening and continue to learn!

Job Summary and Qualifications

As a Case Manager, your role will be to support patients and families through every step of their care journey. You will coordinate services, connect resources, and develop care plans that reflect each patient’s unique needs. By partnering with physicians, nurses, and department leaders, you will help ensure safe transitions, clear communication, and consistent quality across the continuum of care. 

Your responsibilities will include:

  • Guiding patients and families through program orientation, explaining the rehabilitation philosophy, Medicare and insurance benefits, discharge criteria, and patient rights 
  • Coordinating education for patients, families, and caregivers to encourage participation in treatment planning, goal discussions, and family conferences 
  • Developing and implementing individualized treatment plans that reflect the patient’s strengths, needs, and personal recovery goals 
  • Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team 
  • Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care 
  • Promoting HCA Healthcare’s values of compassion, respect, and excellence through every patient and family interaction 
What qualifications you will need:
  • Basic Cardiac Life Support must be obtained within 30 days of employment start date
  • (RN) Registered Nurse
  • Masters Degree, or Bachelors Degree, or Associate Degree
  • 1 year RN Case Manager experience in an acute care setting 

Founded as Valley Community Hospital in 1975, Valley Regional Medical Center proudly serves Brownsville, TX and the surrounding communities in the Rio Grande Valley. Valley Regional Medical Center is a licensed 215+ bed facility with over 200 physicians representing 25+ specialties. From emergency medicine, to diagnostic imaging services, and caring for newborn babies, Valley Regional Medical Center is the hospital that families count on when they are looking for quality healthcare close to home. We are a designated Advanced Level III Trauma Center and an Advanced Primary Stroke Center. Our Heart and Vascular services include a full-range of cardiac services including minimally invasive and open-heart surgery, cardiac cath lab, heart imaging services and more. Our women’s department includes labor, delivery and recovery in a home-like setting. We also have a C-section operating room on standby 24 hours a day and a Level III Neonatal Intensive Care Unit equipped with specially trained staff. Innovation and an unwavering commitment to patient care are the cornerstones of our hospital. Come experience our family centered culture at Valley Regional.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.


"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If growth and continued learning is important to you, we encourage you to apply for our Registered Nurse RN Case Management opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. Unlock the possibilities apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Not Specified
Registered Nurse Case Manager PRN
Salary not disclosed
Conroe, TX 5 days ago
Introduction

Do you have the PRN career opportunities as a(an) RN Case Mgr PRN you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Conroe which is part of the nation's leading provider of healthcare services, HCA Healthcare.

Benefits

HCA Houston Healthcare Conroe, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
  • Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  • Fertility and family building benefits through Progyny
  • Free counseling services and resources for emotional, physical and financial wellbeing
  • Family support, including adoption assistance, child and elder care resources and consumer discounts
  • 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  • Employee Stock Purchase Plan
  • Retirement readiness and rollover services and preferred banking partnerships
  • Education assistance (tuition, student loan, certification support, dependent scholarships)
  • Colleague recognition program
  • Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) RN Case Mgr PRN where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

As a Case Manager, your role will be to support patients and families through every step of their care journey. You will coordinate services, connect resources, and develop care plans that reflect each patient’s unique needs. By partnering with physicians, nurses, and department leaders, you will help ensure safe transitions, clear communication, and consistent quality across the continuum of care. 

Your responsibilities will include:

  • Guiding patients and families through program orientation, explaining the rehabilitation philosophy, Medicare and insurance benefits, discharge criteria, and patient rights 
  • Coordinating education for patients, families, and caregivers to encourage participation in treatment planning, goal discussions, and family conferences 
  • Developing and implementing individualized treatment plans that reflect the patient’s strengths, needs, and personal recovery goals 
  • Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team 
  • Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care 
  • Promoting HCA Healthcare’s values of compassion, respect, and excellence through every patient and family interaction 
What qualifications you will need:
  •  ​Associate Degree in Nursing or Nursing Diploma ​​Required,​Bachelor’s Degree in Nursing ​​Preferred​
  • ​2+ years experience in case management OR 3+ years experience in clinical nursing ​​Required​
  • ​InterQual experience ​​Preferred​​​
  • ​Currently licensed as a Registered Nurse in the state(s) of practice according to law and regulation. 

At HCA Houston Healthcare Conroe, superior healthcare meets the comfort and convenience of a comprehensive hospital, close to home, in Conroe, Texas. We have been providing high-quality healthcare to the Montgomery County region for more than 80 years. During that time we have grown to become a full-service 330+ bed medical center and a tertiary referral center – all while remaining true to our mission of providing care, above all else. As a regional, tertiary referral center, other hospitals rely on us when higher levels of acute care are necessary. HCA Houston Conroe was the first hospital in Montgomery County to achieve the designation of a Level II Trauma Center. We are also a Certified Primary Stroke Center, an Accredited Chest Pain Center, and a designated Level III Neonatal ICU in order to treat for the most vulnerable patients of all ages. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.


"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our RN Case Mgr PRN opening. We review all applications. Qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status

Not Specified
RN Unit Base Case Manager - WIP Day Shift
✦ New
Salary not disclosed
Wilmington, DE 1 day ago

RN Case Manager – Weekender - Day Shift

Saturday & Sunday (Plus one rotating Friday shift 4-8pm). 

Wilmington, DE

ChristianaCare - Wilmington Hospital is currently recruiting an RN Acute Care Case Manager - Weekender with experience in Transitional Care or Discharge Planning in an Acute Care Hospital Setting

As part of our Weekend Incentive Program (WIP), you will be required to work 3 out of 4 weekends in a four-week schedule. This includes a 12-hour day shift on Saturdays and Sundays, along with one rotating Friday shift.  Additionally, there will be an annual rotating holiday every other year.

Weekend Incentive Program Includes: Special rate of pay and full benefits, except for Paid Time Off (PTO).

The RN Case Manager will be responsible for managing patient care, driving patient progression, and establishing a discharge plan. This includes functioning as a member of the interdisciplinary team, creating, implementing, and monitoring treatment plans to ensure safe, timely, and effective transitions throughout the care continuum and discharge planning.

The Care Management Model: 

Our Care Management Triad Team Model is a collaboration between the following:

  • RN Case Manager - Manages patient care, drives patient progression, and establishes a discharge plan.

  • Social Worker – Resolves psycho-social barriers and supports discharge needs.

  • Utilization Management – Reviews patient status for appropriateness and anticipated payer coverage.

CARE MANAGEMENT:

  • Identify patients who have post-acute care, placement, and complex discharge planning needs based on a comprehensive assessment that includes physical, as well as psycho-social factors/needs.

  • Anticipate, initiate, and establish a discharge plan for patients with post-acute care needs, collaborating with the physician, nurse, and other health care providers, the patient, their family/primary caregiver(s), third-party payers, and employer following established clinical guidelines, standards, and pathways.

  • Review the admission assessment and collaborate with the primary nurse and other health care providers to ensure a multidisciplinary care plan is in place to meet identified patient care needs and desired outcomes.

  • Identify system issues that serve as barriers to care.  Participates in the development and implementation of strategies to remove barriers and facilitate patient progression.

About Us

ChristianaCare is located in Delaware and is one of the country’s most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs.

ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a freestanding emergency department, a Level I trauma center, and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care, and women’s health. It also includes the pioneering Gene Editing Institute.
 

Education & Requirements

  • An active RN license in DE or a Compact State is required.

  • BSN required.

  • One year of experience as an RN Case Manager preferred.

  • Experience in an inpatient hospital setting with a focus on acute care is required.

  • BLS preferred.

  • Case Management Certification (CMC) is required within 18 months of eligibility.

This is a flat-rate position. With benefits, the WIP rate is $35 plus a $10 shift differential. Without benefits, the rate is $40 plus a $20 shift differential. WIP positions are merit eligible.This pay rate/range represents ChristianaCare’s good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements.

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

temporary
RN Case Manager - Bilingual
$100,000 to $115,000 per year
Bronx, NY 6 days ago
RN Case Manager – MLTC (Bilingual highly preferred) – Hybrid (4 days remote)

Job Summary:

The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.

Essential Functions:

  • Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.
  • Authorizes covered services and coordinates care regardless of payer.
  • Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
  • Works with member/family to maintain the most independent living situation possible
  • Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
  • Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
  • Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
  • Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
  • Ensures appropriate, safe plan for members’ discharge from their plan.
  • Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
  • Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
  • Responds to members’ requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated
  • Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
  • Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
  • Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members’ needs.
  • Perform any other job related duties as requested.


Education and Experience:


  • Associates degree in Nursing from an accredited nursing program required
  • Bachelor's degree in Nursing preferred
  • Three (3) years of experience as a registered nurse required
  • Clinical experience in geriatrics and/or managed long-term care experience preferred
  • Experience using multiple languages may be required based on operational needs

Competencies, Knowledge and Skills:


  • Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
  • Ability to communicate effectively with a diverse group of individuals
  • Ability to multi-task and work independently within a team environment
  • Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
  • Adhere to code of ethics that aligns with professional practice
  • Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
  • Strong advocate for members at all levels of care
  • Strong understanding and sensitivity of all cultures and demographic diversity
  • Ability to interpret and implement current research findings
  • Awareness of community & state support resources
  • Critical listening and thinking skills
  • Decision making and problem-solving skills
  • Strong organizational and time management skills
  • Bilingual speaking and writing skills are preferred

Licensure and Certification:


  • Current, unrestricted Registered Nurse licensure in the state of New York required
  • Case Management Certification preferred

Working Conditions:


  • General office environment; may be required to sit or stand for extended periods of time
  • Up to 25% (regular) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties

Compensation Range:

$100,000 - $115,000.. We takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

#AC1

#ACP
Not Specified
Registered Nurse RN Case Manager PRN
Salary not disclosed
Tomball, TX 5 days ago

As a Registered Nurse RN Case Manager PRN, your  voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives. You'll help shape decisions that elevate both patient outcomes and the future of nursing.

Do you want to work where you have a voice? Nurses are at the forefront of our commitment to the care and improvement of human life. At HCA Healthcare, there are many ways for nurses to have a voice through professional practice councils, advisory councils, vital voices surveys, and units of distinction. We learn from our multi-generational nursing family. We partner with our Nurses at HCA Houston Healthcare Tomball!

Job Summary and Qualifications

As a Case Manager, your role will be to support patients and families through every step of their care journey. You will coordinate services, connect resources, and develop care plans that reflect each patient’s unique needs. By partnering with physicians, nurses, and department leaders, you will help ensure safe transitions, clear communication, and consistent quality across the continuum of care. 

Your responsibilities will include:

  • Guiding patients and families through program orientation, explaining the rehabilitation philosophy, Medicare and insurance benefits, discharge criteria, and patient rights 
  • Coordinating education for patients, families, and caregivers to encourage participation in treatment planning, goal discussions, and family conferences 
  • Developing and implementing individualized treatment plans that reflect the patient’s strengths, needs, and personal recovery goals 
  • Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team 
  • Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care 
  • Promoting HCA Healthcare’s values of compassion, respect, and excellence through every patient and family interaction 
What qualifications you will need:
  • Current Registered Nurse License in the State of Texas or Multi-State Compact License (Employees with RN Compact License are required to obtain Texas RN License within 90 days of hire date)
  • Graduate of an accredited school of professional nursing is required
  • BSN preferred
  • 3+ years RN experience in an acute care setting
  • 2 years of supervisory experience is preferred
  • Case Manager Cert preferred
  • InterQual experience preferred 
Benefits

HCA Houston Healthcare Tomball, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
  • Wellbeing support, including free counseling and referral services
  • Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
  • Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
  • Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
  • Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

"Nurses play a pivotal role and are the backbone of healthcare delivery. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing."

Sammie Mosier, DHA, MA, BSN, NE-BC

Senior Vice President and Chief Nursing Executive, HCA Healthcare

HCA Houston Healthcare Tomball has provided quality healthcare to Tomball, Magnolia and Northwest Houston communities since 1948. Fully accredited by The Joint Commission, our 350+ bed hospital is on a 150-acre campus that features designated specialty centers: The Orthopedic Center, The Women’s Center, the Heart and Vascular Center and the Texas Sports Medicine Center. Our services include a Level III Trauma Center, advanced robotic surgery program with 24/7 service, Joint Commission-certified Primary Stroke Center, comprehensive Women's Services and Labor & Delivery unit with Level II Neonatal Intensive Care Unit (NICU), orthopedic care including joint replacement, and much more. We are committed to providing quality healthcare while making a difference in our patients’ lives. Through exceptional technology and specialized medical staff, area residents receive a full range of medical services, close to home. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

If this opportunity is your next step in your career path, we encourage you to apply for our Registered Nurse RN Case Manager PRN opening. We review all applications. Qualified candidates will be contacted by a member of our team. We are interviewing apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Not Specified
RN Case Manager - Inpatient Case Management Everet
Salary not disclosed
Everett, MA 3 days ago

Location: CHA Everett Hospital 
Work Days: Mon - Friday and Rotating Weekends/Holiday
Category: Registered Nurse
Department: Inpatient Case Management Everett  
Job Type: Part Time
Work Shift: Day 
Hours/Week: 24.00 
Union Name: MNA Everett

Department Description

Inpatient Case Management provides psychosocial assessments, evaluations, and referrals for adults, and/or families with psychiatric illness, substance abuse, and medical illness. Casework or therapy takes place in the hospital setting. Cross Training to all areas of Care Management.

Under the general supervision of the Director of Care Management, the RN Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate with other members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilize criteria to confirm medical necessity for admission and continued stay. With the patient, family and health care team, create a post-acute care plan appropriate to the patient's needs and resources and facilitate this transition in concert with that patient's inpatient and post-acute care teams. 

Qualifications/Requirements:

  • BSN preferred
  • Current or Conditional MA RN Licensure 
  • Current American Heart Association (AHA) for Healthcare Providers BLS (Basic Life Support) certification is required 
  • Licensure and Certifications: 
  • Certification in Case Management preferred

Please note that the final offer may vary within the listed Pay Range, based on a candidate's experience, skills, qualifications, and internal equity considerations.

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment. 

Cambridge Health Alliance brings Care to the People - including your neighbors, friends and family. Our local hospitals and care centers serve our vibrant, diverse communities, and play an integral role in improving health. As passionate advocates for the underserved, we actively partner with our communities to take on challenging public health issues, and conduct important research to help reduce barriers to care. We believe that everyone deserves access to high quality, convenient health care. This is why our employees believe in where they work and why many build long, rewarding careers at CHA.


Healthcare is changing rapidly. CHA has a strategic plan that charts a proactive course for our future. It is built on a vision of equity and excellence for everyone, every time. It also recognizes that our workforce is our most valuable asset and prioritizes competitive salaries, benefits and professional development opportunities for employees. The strategic plan is changing the way we provide care and improving the health and experience of our patients; we are looking for smart, committed, compassionate people who want to be part of making our vision of better health and equity a reality.


At CHA, you can believe in where you work and go home every day knowing you made a difference. Join our team and help us bring Care to the People.

Not Specified
Nurse Case Manager (Macomb or Wayne MI) -{167908}
Salary not disclosed
Macomb 2 days ago
Job Title: Nurse Case Manager II (Telephonic)-{167908} Location: Michigan (Must reside in Macomb or Wayne County) Pay: $44.14 per hour Schedule: Monday – Friday | 8:00 AM – 5:00 PM EST Work Setting: Remote (Telephonic – No field work required) Overview We are seeking a Nurse Case Manager II to support care coordination for members with complex and chronic health conditions.

This is a fully remote, telephonic role requiring candidates to work from a quiet, dedicated home office environment.

In this role, the RN Case Manager will conduct comprehensive member assessments, develop individualized care plans, and collaborate with providers and care teams to promote optimal, cost-effective health outcomes.

The position focuses on managing member needs through clinical review, care coordination, and patient engagement.

Key Responsibilities Conduct comprehensive telephonic assessments of member health needs and eligibility using clinical tools and data review.

Develop, implement, and monitor individualized care plans in collaboration with members and interdisciplinary care teams.

Coordinate care and services based on member benefit plans and available internal/external resources.

Apply clinical guidelines, policies, and regulatory standards to ensure appropriate care and benefit utilization.

Provide coaching, education, and support to promote member engagement and healthy lifestyle choices.

Perform crisis intervention and follow-up for members experiencing medical or behavioral health concerns.

Required Qualifications Active, unrestricted Registered Nurse (RN) license in the state of Michigan required.

Minimum 3+ years of clinical practice experience (hospital, home health, or ambulatory care).

Experience in healthcare and/or managed care industry required.

Strong computer skills with the ability to navigate multiple system.

Ability to work independently in a remote environment and adapt to a fast-paced, metrics-driven setting.

Preferred Qualifications Case management experience preferred.

Experience managing chronic conditions (e.g., diabetes, hypertension, asthma).

Experience working with Children’s Special Health Care Services (CSHCS) population preferred.

Experience with motivational interviewing and patient engagement strategies.

Keywords: RN case manager, telephonic case manager, nurse case manager, managed care, care coordination, chronic disease management, utilization management, population health, remote RN, healthcare coordination, patient advocacy, case management, Michigan RN
Not Specified
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