Assess patient from clinical, social, financial perspective and coordinates post-discharge needs with care team.
Functions as a clinical and financial resource for patients and interdisciplinary team members.
Assists in clinical data collection utilizing established criteria and the InterQual system.
Proactively performs utilization review; communicates coverage; Information with third party payers, medical staff and clinical providers.
The Case Manager reports to the Director of the Case Management Services.
The Case Manager meets established deadlines, attends required in-services, maintains staff competencies and completes required documentation; collaborates and works as a team player with all disciplines; presents a professional image to all customers and patients.
Required to be on call as scheduled by the department.
Potential exposure to infectious diseases, potential physical danger from disturbed/irate patients and families.
Emotional stress due to inability to control volume of timing of referrals and necessity to respond to a wide variety of demands and expectations from patients, families, physicians, and other health care professionals.
Occupational exposure to bloodborne pathogens and other infectious materials as defined by OSHA.
This position may have additional or varied physical demand and/or respiratory fit test requirements.

5 years' experience in a variety of clinical settings (i.e., home health, inpatient, physician office, clinic) required.
Experience with managed care and payer/provider requirements preferred.
Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state. BSN preferred.
Excellent interpersonal communication and collaboration skills.
Computer experience required. Windows preferred.

RN Care Manager – Days

Key skills