Title Case Jobs in Usa

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Were changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

Were different than most primary care providers. Were rapidly expanding and we need great people to join our team.

The Nurse Case Manager 1 (RN) is responsible for achieving positive patient outcomes and managing quality of care across the continuum of care. The incumbent in this role will first and foremost serve as an advocate for our patients. He/She works closely with other members of the care team to develop effective plans of care and high levels of care coordination. This care planning and coordination may follow the patient from our centers into acute and post-acute facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves establishing relationships with patients families and care givers, primary care physicians, specialists, other care providers, social workers, other case managers and nurses, acute and post-acute facilities, home health care companies, and health plans. He/She adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance and policies and procedures.

CORE JOB DUTIES/RESPONSIBILITIES:

• Manages and plans for transitions of care, discharge and post discharge follow-up for patients admitted to key, high-volume/high-priority hospitals.
• Establishes a trusting relationship with patients and their caregivers.
• Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals. Reports variations to PCP/Transitional Care Physicians (TCP) and implements actions as appropriate.
• Builds relationships with preferred acute care providers (hospitalists, specialists, etc.).
• Directs referrals to preferred providers.
• Coordinates the integration of social services/case management functions in the pre-acute, ER, acute and post-acute setting. Coordinates the patient care, discharge and home planning processes with hospital case management departments, and other healthcare facilities.
• In conjunction with the PCP, Hospitalist, Medical Director, insurance case manager and the hospital case manager, coordinates the patient transition to the appropriate/least constrictive level of care using a preferred provider.
• Keeps the PCP aware of patient(s) condition via e-mail, DASH, HITS or other appropriate means of communication.
• Introduces self to patient/family and explains Nurse Case Managers role and processes to contact the Nurse Case Manager for questions, guidance and education.
• Provides high intensity engagement with patient and family.
• Facilitates patient/family conferences to review treatment goals and optimize resource utilization; provides family education and identifies post-hospital needs.
• Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient/familys ability to make informed decisions.
• Addresses advanced care planning including treatment goals and advance directives.
• Refers cases to social worker (Hospital and ChenMed/JenCare/Dedicated) for complex psychosocial and economic needs.
• Refers cases where patient and/or family would benefit from counseling required to complete complex discharge plan to social worker.
• Reports observed or suspected child or adult abuse pursuant to mandated requirements.
• Obtains onsite and EMR access at priority facilities.
• Maintains clinical and progress notes for each patient receiving care and provides progress report to PCP and others as appropriate.
• Submits required documentation in a timely manner and in appropriate computer system.
• Participates in surveys, studies and special projects as assigned.
• Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff. Acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
• Promotes effective and efficient utilization of clinical resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframe.
• Conducts review for appropriate utilization of services from admission through discharge. Evaluates patient satisfaction and quality of care provided.
• Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians to maintain appropriate cost, case and desired patient outcomes.
• Coordinates the provision of social services to patients, families and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.
• Completes expanded assessment of patients and family needs at time of admission. Completes psychosocial assessment.
• Directs and participates in the development and implementation of patient care policies and protocols to provide advice and guidance in handling unusual cases or patient needs.
• Attends meetings as assigned
• Performs other duties as assigned and modified at managers discretion.

There are 4 Nurse Case Manager 1 Roles with additional Essential Job Functions:

Acute Case Manager (primarily hospital based)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Identify appropriateness of inpatient vs. observation status.
• Identify and manage safety risk (complete a social assessment), identify functional status (ADLs and PT needs), discuss medications and self-management, identify and correct knowledge deficits.
• Implement the ACM Coaching program with the appropriate patient population.
• In markets as appropriate, when patient in SNF, in conjunction with the post-acute physician, coordinate the transition to a lower level of care as soon as appropriate using a preferred provider if further services are needed.
• Facilitate discharge to appropriate level of care and preferred providers
• Communicate discharge to all stakeholders including PCP, Center Manager and Community Case Manager.
• Document the appropriate date that the patient is medically discharged and update as appropriate.
• Contact the center manager to arrange for a follow-up PCP appointment prior to discharge and whenever possible, communicate this information to the patient/caregiver.
• As appropriate, discuss patients eligibility for CCM or DM programs and identify patient interest in participation.
• Coordinate acute UR physician meetings.

Community Case Manager (primarily clinic and community based)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Provides telephonic or outpatient visits to patients at high-risk for readmissions (as identified by CM Plan) to the ER or hospital, to patients with active care planning requirements, to disease management patients per the Disease Management Plan and to others as referred via transitional care team, acute case managers and Transitional Care team.
• Visits may include evening and weekend hours with the goal of preventing ER visits or hospital admissions.
• Performs clinical functions including disease-oriented assessment and monitoring, medication monitoring, health education and self-care instructions in the outpatient setting.

Coordinate the Plan of Care:

• Conducts/coordinates initial case management assessment of patients to determine outpatient needs.
• Ensures individual plan of care reflects patient needs and services available.
• Makes recommendations to the team.
• Completes individual plan of care with patients and team members.
• Communicates instructions and methodologies as appropriate to ensure that the plan is implemented correctly.
• Assesses the environment of care, e.g., safety and security.
• Assesses the caregiver capacity and willingness to provide care.
• Assesses patient and caregiver educational needs.
• Coordinates, reports, documents and follows-up on Super Huddles and HPP/IDT meetings.
• Helps patients navigate health care systems, connecting them with community resources; orchestrates multiple facets of health care delivery and assists with administrative and logistical tasks.
• Coordinates the delivery of services to effectively address patient needs.
• Facilitates and coaches patients in using natural supports and mainstream community resources to address supportive needs.
• Maintains ongoing communication with families, community providers and others as needed to promote the health and well-being of patients.
• Establishes a supportive and motivational relationship with patients that support patient self-management
• Monitors the quality, frequency and appropriateness of HHA visits and other outpatient services.
• Assists patient and family with access to community/financial resources and refer cases to social worker as appropriate.

Community/Skilled Nursing Facility Case Manager (Community Case Manager Role with additional SNF duties as assigned)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Community Case Manager role as above.
• CM telephonic or onsite visits to SNFs, communication with physical therapists (PT), social workers, patient and families as appropriate.
• Validates appropriate level of care/LOS.
• Validates Discharge plan for safe transition home, utilization of preferred providers or timely transition to long term care.
• Reminds patient of need for 4-day PCP post hospital/SNF discharge visit and future visits.
• Collaborates with payor onsite SNF CMs.

Transitional Case Manager (Blended Acute and Community Case Manager Roles)

Responsibilities include all the above Core duties/responsibilities plus the following:

• Acute and Community Case Manager roles as above.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Critical thinking skills required.
• Ability to work autonomously is required.
• Ability to monitor, assess and record patients progress and adjust and plan accordingly.
• Ability to plan, implement and evaluate individual patient care plans.
• Knowledge of nursing and case management theory and practice.
• Knowledge of patient care charts and patient histories.
• Knowledge of clinical and social services documentation procedures and standards.
• Knowledge of community health services and social services support agencies and networks.
• Organizing and coordinating skills.
• Ability to communicate technical information to non-technical personnel.
• Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
• Ability and willingness to travel locally, regionally and nationwide up to 10% of the time.
• Spoken and written fluency in English.
• Bilingual preferred.

PAY RANGE:

$36.9 - $52.70 Hourly

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

EMPLOYEE BENEFITS

Were ChenMed and were transforming healthcare for seniors and changing Americas healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. Were growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in peoples lives every single day.

Current employees, if you want to apply to our internal career site, please click HERE

Current Contingent Worker please see job aid HERE to apply

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Location Address:

Compensation Pay Range:

Summary:

How you grow, learn and thrive matters here.
• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

Responsibilities:

• Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
• Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload
• Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
• Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload.
• Formulates, implements, coordinates, monitors, and evaluates strategies for patients and families collaboratively with members, families and health care teams. Develops, documents and implements plans which provide appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
• Actively participates in the development of clinical guidelines and pathways and incorporates processes into the role of case managers.
• Educates providers on health management strategies which can reduce need for one-on-one case management services. Educate physicians, nurses, ancillary support staff, patients, and families regarding case management role.
• Refers patients to appropriate inpatient, outpatient, and community resources.
• Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and patient satisfaction. Collect clinical path variance data that indicate potential areas for improvement of case and services provided within the system. Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
• Complies with Case management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.
• Performs other functions as required.

Qualifications:

*Associates Degree in Nursing

*State of New Mexico or Compact State Nursing License

*BLS certification REQUIRED at at time or hire

*Five years of experience in clinical nursing with a minimum of three to five in case management, utilization management, quality assurance, home care, community health, or occupational health.

*CCM certification within 3 years of hire. 

*Employee Health experience preferred. 

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

Schedule:

• Monday-Friday, flexible day shift hours
• Unit support/coverage as needed

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs.  The Case Manager’s focus is to maintain patients at an optimal level of health and to support self-care.  Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost effective quality care and to achieve optimal outcomes. 

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services.  Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.  Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge.  The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures.  The Case Manager is accountable for improving service using cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.   

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third-party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.     

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and always conducts oneself in a manner consistent with these values.  

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. 

• Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served. 

• Exhibits sound judgment, critical thinking, problem solving and decision-making skills. 

• Communicates effectively with patients, significant others, and members of the health care team.  

• Compiles information; keeps records, prepares or directs preparation of reports and correspondence. 

• Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.  

• Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay.  Demonstrates ability to promote collaboration and creativity among members of the health care team. 

• Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.   

• Reports potential catastrophic and high-cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management. 

• Effectively manages length of stay and cost avoidance.   

• Discuss cases with Utilization Review Committee and/or Executive Health Resources (EHR) when cases fail to meet admission, treatment, and length of stay and/or discharge standards.  

• Attends meetings of the Utilization Review Committee and submits reports as required.  Participates in the development of a written plan that describes the Utilization Review Program. 

• Applies quality improvement methods and techniques to improve case management processes to maximize cost and quality benefits for MercyOne Medical Center.  

• Performs other duties consistent with the purpose of the job as directed. 

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

• Must be a registered nurse and must hold an active license to practice nursing in the state of Iowa. 

• Knowledge of clinical practice and case management processes normally acquired by completing a bachelor’s degree in nursing. 

• Training and/or Certification in the area of case management is preferred.   

• Must meet all mandatory education and training requirements within specified timeframes as required by organizational/regulatory standards. 

• Three to five years’ clinical experience required.   

Schedule:

• Monday-Friday, flexible day shift hours
• Unit support/coverage as needed

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs.  The Case Manager’s focus is to maintain patients at an optimal level of health and to support self-care.  Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost effective quality care and to achieve optimal outcomes. 

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services.  Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.  Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge.  The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures.  The Case Manager is accountable for improving service using cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.   

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third-party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.     

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and always conducts oneself in a manner consistent with these values.  

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. 

• Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served. 

• Exhibits sound judgment, critical thinking, problem solving and decision-making skills. 

• Communicates effectively with patients, significant others, and members of the health care team.  

• Compiles information; keeps records, prepares or directs preparation of reports and correspondence. 

• Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.  

• Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay.  Demonstrates ability to promote collaboration and creativity among members of the health care team. 

• Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.   

• Reports potential catastrophic and high-cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management. 

• Effectively manages length of stay and cost avoidance.   

• Discuss cases with Utilization Review Committee and/or Executive Health Resources (EHR) when cases fail to meet admission, treatment, and length of stay and/or discharge standards.  

• Attends meetings of the Utilization Review Committee and submits reports as required.  Participates in the development of a written plan that describes the Utilization Review Program. 

• Applies quality improvement methods and techniques to improve case management processes to maximize cost and quality benefits for MercyOne Medical Center.  

• Performs other duties consistent with the purpose of the job as directed. 

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

• Must be a registered nurse and must hold an active license to practice nursing in the state of Iowa. 

• Knowledge of clinical practice and case management processes normally acquired by completing a bachelor’s degree in nursing. 

• Training and/or Certification in the area of case management is preferred.   

• Must meet all mandatory education and training requirements within specified timeframes as required by organizational/regulatory standards. 

• Three to five years’ clinical experience required.   

Schedule:

• Monday-Friday, flexible day shift hours
• Unit support/coverage as needed

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs.  The Case Manager’s focus is to maintain patients at an optimal level of health and to support self-care.  Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost effective quality care and to achieve optimal outcomes. 

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services.  Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.  Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge.  The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures.  The Case Manager is accountable for improving service using cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.   

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third-party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.     

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and always conducts oneself in a manner consistent with these values.  

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. 

• Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served. 

• Exhibits sound judgment, critical thinking, problem solving and decision-making skills. 

• Communicates effectively with patients, significant others, and members of the health care team.  

• Compiles information; keeps records, prepares or directs preparation of reports and correspondence. 

• Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.  

• Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay.  Demonstrates ability to promote collaboration and creativity among members of the health care team. 

• Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.   

• Reports potential catastrophic and high-cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management. 

• Effectively manages length of stay and cost avoidance.   

• Discuss cases with Utilization Review Committee and/or Executive Health Resources (EHR) when cases fail to meet admission, treatment, and length of stay and/or discharge standards.  

• Attends meetings of the Utilization Review Committee and submits reports as required.  Participates in the development of a written plan that describes the Utilization Review Program. 

• Applies quality improvement methods and techniques to improve case management processes to maximize cost and quality benefits for MercyOne Medical Center.  

• Performs other duties consistent with the purpose of the job as directed. 

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

• Must be a registered nurse and must hold an active license to practice nursing in the state of Iowa. 

• Knowledge of clinical practice and case management processes normally acquired by completing a bachelor’s degree in nursing. 

• Training and/or Certification in the area of case management is preferred.   

• Must meet all mandatory education and training requirements within specified timeframes as required by organizational/regulatory standards. 

• Three to five years’ clinical experience required.   

General Summary of Position

An exciting new role has been added to the team, offering a unique opportunity to make a direct impact on patient outcomes at a critical point in care. The In-Hospital Transition of Care RN Case Manager partners closely with hospital discharge planners to coordinate patient care at discharge, ensuring seamless continuity across care settings and reducing avoidable readmissions through proactive coordination, patient education, and timely follow-up.

This position is based at either Washington Hospital Center or The Psychiatric Institute of Washington (PIW) and offers the opportunity to work across diverse patient populations, with flexibility to provide coverage at both locations.

In this highly collaborative and autonomous role, the RN Case Manager manages a complex caseload and takes ownership of case management program(s), driving high-quality, cost-effective outcomes while enhancing the patient experience. The role includes coordinating and managing care for members/enrollees, completing pre-authorization reviews to ensure medical necessity and timely access to services, and conducting pharmacy reviews aligned with the population served. Working alongside an interdisciplinary team, you will play a key role in discharge planning, connecting patients to the right resources, and ensuring smooth transitions across the continuum of care.

This is an excellent opportunity for a nurse who thrives in a fast-paced environment, values critical thinking and autonomy, and is passionate about improving care transitions and patient outcomes. We are committed to fostering a supportive, inclusive environment where associates from diverse backgrounds can grow, advance, and make a meaningful difference.

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.
• Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
• Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
• Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
• Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
• Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. 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.
• Provides face to face case management in the community as the member/enrollee's health necessitate.
• Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
• Demonstrates skill and flexibility in providing coverage for other staff.
• For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
• Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
• Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
• Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
• Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy.
• Monitors utilization of all services for fraud waste and abuse.
• Performs telephonic ACD line coverage for Clinical Operations' needs.
• Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
• Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications
Education

• Graduate of an accredited School of Nursing required and
• Bachelor's degree preferred

Experience

• 1-2 years Case management experience required and
• 1-2 years UM or related experience required and
• 3-4 years Diverse clinical experience required
•  

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and
• CCM - Certified Case Manager Upon Hire preferred

Knowledge Skills and Abilities

• Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.

Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at Valley Regional Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse RN Case Manager you can be a part of change.

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.

It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential and see how rewarding it can be to reach your personal and professional goals. Help to advance the practice of nursing and improve positive outcomes for your patients as a (an) Registered Nurse RN Case Manager. We want your knowledge and expertise!

We are seeking a RN Case Managerfor our facility to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other, and we are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now!

What You Will Do In Your Role:

• You will be responsible for promoting patient-centered care by coordinating all aspects of hospital-based case management for his/her assigned area of responsibility in alignment with the goals of the Case Management Department
• You will be accountable for the overall day-to-day oversight and management of the case management program including coordination, supervision, and administrative oversight of the case management team
• You will function as an expert clinical practitioner, case management subject-matter expert, resource, advisor and leader for the members of the case management team
• You will supervise and monitor professional and support staff and ensures that effective care coordination and case management practices are consistent with hospital policies, and applicable regulations and guidelines
• You will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization

• 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
• 3+ years of RN experience in an acute care setting
• Case Management experience preferred

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.

Be a part of an organization that leverages our size to make a real impact in our industry! Our Talent Acquisition team is reviewing applications for our Registered Nurse RN Case Manager opening. Submit your application today and help advance the practice of nursing.

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.