Position: RNCase Manager
Location: 100% Remote (Must be local to the state of Indiana)
Duration: 6-month Contract with potential for full-time conversion
Start: December 2024
Overview:
The RN Case Manager plans and coordinates care for patients from pre-admission through post-discharge by working collaboratively with the multidisciplinary team. Ensures that patients are assigned the appropriate level of care, receive the appropriate services and are transitioned to the appropriate post-discharge level of care. Performs accurate, timely and effective discharge planning for patients. Works with third party payers to ensure coverage. Administers education and prevention programs.
Qualifications:
- Associate's Degree in Nursing or Bachelor's Degree in Social Work required.
- Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license OR a Social Work license in the state of Indiana.
- Certification in Case Management preferred.
- Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation is preferred.
- Knowledge of Medicare/Medicaid, insurance and regulatory guidelines is preferred.
- Ability to comprehend third party contractual arrangements is preferred.
- Understanding of the third party denial and appeal process is preferred.
- Requires knowledge of various software applications including Windows; Cerner; MCCM; and SMS.
- 3-5 years of experience preferred
