Case Management Nurse New

Position: RN Case Manager

Client: Large Provider Client

Location: Remote, must be local to Indiana

Duration: 6-month Contract-to-Hire

Schedule: Full-time, Monday-Friday, 8am-5pm EST

Start Date: June 2025

Summary

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.

Requirements

• 3-5 years of Case Managemenet experience preferred.
• Associate's or Bachelor's Degree in Nursing required.
• Experience with Complex and/orTransition of Care Case Management preferred.
• Experience working in a managed care environment preferred.
• Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• 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.