Registered Nurse (RN) – Inpatient Case Manager job in Bloomington, MN, USA. by Amery Hospital & Clinic

Requirements

Mid level
Current unrestricted Registered Nurse license in the State of Minnesota
License free of restrictions or sanctions in the past 10 years in all states of licensure
Minimum 3 years of RN clinical experience in utilization review, case management or discharge planning
Excellent verbal, written and interpersonal skills
Excellent problem identification, problem solving and follow-through skills
Excellent organizational skills and ability to prioritize workload
Ability to deal with change and ambiguous situations
Basic computer skills

Bachelor of Science or Arts degree in nursing (BSN) from an accredited college or university
Experience with utilization review criteria
Public health or home care experience
Understanding of managed care and case management concepts
Basic understanding of healthcare economics and consumerism within healthcare
CCM, CMC or equivalent case management certification

Provide on-site and/or telephonic inpatient case management and concurrent review for medical/surgical members
Monitor medical necessity, appropriateness and efficiency of care using established inpatient guidelines
Perform utilization management for members admitted to out-of-network and acute rehabilitation facilities
Facilitate communication between patient, family, physician, social services and vendors
Work with physicians, specialists and hospital staff to create plans of care and transition/discharge plans
Record, monitor and report data such as clinical outcomes, denials, length of stay and discharge dispositions