Case Manager-PRN
On-siteIndianapolis, Indiana, United States
Job Summary
Plan and coordinate patient care from pre-admission through post-discharge, ensuring appropriate levels of care and services. Perform accurate and timely discharge planning, including documentation and communication with patients, families, and providers. Collaborate with the multidisciplinary team to develop comprehensive care plans while working with third-party payers to verify coverage, administer education programs, and assist with denials and appeals. Educate patients and families on post-discharge safety and prevention strategies. Ensure compliance with Medicare, Medicaid, and regulatory guidelines using Cerner, MCCM, and SMS applications. Requires active RN license in Indiana or NLC, Associate's Degree in Nursing, and 3-5 years of acute care experience. Monday through Friday 8:00a – 4:30p.
Required Qualifications
- Associate's Degree in Nursing
- Active RN license in Indiana or Nurse Licensure Compact (NLC)
- 3-5 years of clinical experience in acute care
- Knowledge of InterQual Acute Level of Care Criteria and federal coverage guidelines
- Familiarity with Medicare/Medicaid, insurance, and regulatory guidelines
- Ability to understand third-party contractual arrangements and denial/appeal processes
- Proficiency with Windows, Cerner, MCCM, SMS, and other relevant software applications
- Strong clinical background
- Excellent assessment skills
- Excellent communication skills
Desired Qualifications
- Case Management certification
- BSN within 5 years of hire (for RNs hired after January 1, 2013)
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