Case Management RN

About the Role:

The Case Management RN is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves conducting prospective, concurrent, and retrospective reviews to ensure optimal resource utilization and compliance with clinical guidelines and payer policies. This position ensures that patients receive high-quality, cost-effective care while promoting optimal health outcomes and patient satisfaction. The RN collaborates closely with multidisciplinary teams, including physicians, social workers, and other healthcare professionals. Additionally, the role involves continuous monitoring and evaluation of patient progress to initiate and maintain timely communication with payers to facilitate authorization processes.

Minimum Qualifications:

Preferred Qualifications:

Responsibilities:

A conditional job offer is contingent upon successfully passing a pre-employment drug test and background checks. A Physical Capacity Profile may be required for some positions.