RN Case Manager

JOB RELATIONSHIPS
- Reports to the Director of Research and Innovation in collaboration with the CNO/VP of Patient Care
  Services
DEFINITION OF POSITION
- The Registered Nurse (RN) Care Manager will:
  - Conduct a comprehensive assessment and develop thoughtful plans to implement, coordinate, monitor,
    and evaluate healthcare services tailored to meet each individual’s specific needs in a cost-effective
    manner.
  - Perform utilization reviews to assess the appropriateness and medical necessity of healthcare services
    for patients, while fostering strong relationships with payers to ensure compliance and alignment.
  - Foster strong relationships with payers to ensure compliance and alignment
  - Act as a patient advocate to guide patients through the complex healthcare system, ensuring their
    preferences and rights are respected and helping them access appropriate care or coverage
  - Facilitate coordinated patient care by collaborating with patients, their families, healthcare staff,
    physicians, Advanced Practice Provider (APPs) and community services, all aimed at promoting quality
    care.
  - Incorporate cultural competence and awareness of Social Determinants of Health (SDOH) into assessment
    and care plan development to ensure a holistic approach to patient well-being
  - Take the lead on discharge planning and care coordination initiatives, with the goal of minimizing
    readmissions.
  - Work closely with interdisciplinary teams to create and refine patient-centered care plans.
  - Regularly monitor key performance indicators (KPIs), such as length of stay and readmission rates, to
    ensure optimal service delivery.
  - Uphold stringent adherence to guidelines established by CMS, the Joint Commission, and all relevant
    payer requirements.
QUALIFICATIONS
- Professional
  - Registered nurse with current North Carolina license (BSN preferred).
  - Current BLS Healthcare Provider certification.
  - Three years clinical experience in a health care facility with knowledge base of clinical nursing principles
  - Case Management Certification (CCM), Accredited Case Manager (ACM) and/or Health Care Quality and Management (HCQM) certification preferred
  - Knowledge of current trends and issues related to utilization and case management principles related to the hospital practice setting.
  - Computer experience
  - Evidence of participation in ongoing continuing education programs.

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Carteret Health Care

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