Case Manager RN

Cooperidge Consulting Firm is seeking a Case Manager Registered Nurse (RN) for a top Healthcare client. The RN Case Manager serves as a Care Coordinator, facilitating the interdisciplinary plan of care with a focus on evaluating clinical appropriateness, medical necessity, level of care, and resource utilization.

Requirements

• Perform comprehensive assessments of the psychosocial and medical needs of assigned patients to develop a detailed case management plan of care.
• Evaluate admissions for medical necessity and appropriate observation status using approved criteria, escalating issues through the established chain of command as needed.
• Assume a leadership role with the interdisciplinary team to manage care, ensuring appropriate level of care, patient status, and resource utilization are maintained.
• Perform utilization management reviews and communicate crucial information to third-party payors, acting as a liaison between all parties (physicians, hospital staff, outside agencies).
• Ensure compliance with all regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to the provision of Case Management Services.
• Document professional recommendations, care coordination interventions, and case management activities accurately to ensure effective communication across the healthcare team.

Benefits

• Competitive pay with opportunities for overtime and weekend shifts.
• Comprehensive medical, dental, and vision insurance.
• Life insurance and disability coverage.
• 401(k) retirement plan with employer match.
• Paid time off — vacation, sick leave, and holidays.
• Continuing education and professional development opportunities.