Rn Case Manager

Summary

Join Beam Healthcare as a Registered Nurse (RN) Case Manager and contribute to our inpatient and ED case management program. This work-from-home position requires 3+ years of inpatient case management experience and proficiency with InterQual and Milliman software. You will actively manage patient care from admission to discharge, ensuring compliance with regulations and collaborating with a multidisciplinary team. Responsibilities include utilization review, leading monthly meetings, and coordinating with various departments. The role offers a competitive salary and the opportunity to work with a passionate team dedicated to healthcare equality.

Requirements

• 3+ years experience in prior case manager experience in the inpatient setting
• Graduate of accredited school of nursing or education equivalency for licensing
• Proficiency with case management software platforms - InterQual and Milliman
• Excellent written and verbal communication skills
• Active RN Licensure in the state of TX

Responsibilities

• Actively work with ER/Hospitalist for any new obs/admission request to ensure proper status from admission
• Ensures compliance with Condition of Participation (CoP) discharge planning
• Identifies and escalates gaps/barriers related to inpatient and observation length of stay
• Attend Patient/Family meetings as needed
• Assesses patients at high risk for readmission. Identifies root cause for readmission. Develops plan and collaborates with multidisciplinary team regarding discharge planning to next level of care
• Provides discharge care coordination for HHS, Hospice, ALF, and SNF. Communicates with health unit coordinator for appointments/follow ups and therapy re: DME needs prior to and upon discharge
• Participates with other members of team regarding opportunities for improvement in standard work
• Actively participates in utilization management process, admission process, and act as a case manager liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.)
• Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's Scope of Service
• Performs other duties as assigned
• Utilization review on an ongoing basis
• Lead monthly UR meeting includes monthly reports with trends and input. This will also be sent to CEO, CFO, CNO, and Hospitalist director + Med Surg manager
• Aid in Insurance authorization coordination
• Weekly meeting prn with PFS regarding authorizations and denied claims
• Denial coordination with the business office on hospitalized patient denials
• Coordinate peer to peer requested by the business office and provide the business office supportive clinical information
• Prepare for Monthly UR meetings including monthly reports with trends and input

Benefits

Work from Home