RN Case Manager

Manage the continuum of care from admission through discharge for assigned patients by partnering with medical staff, utilizing scientific evidence, and implementing patient-focused long and short-term goals. Collect and report utilization data, quality information, and compliance metrics regarding delays, preventable conditions, and readmissions. Assist in preparing UM/QI case issues, consult with nursing staff in care areas, and educate them on state and federal regulations for accreditation. Provide instruction to hospitalized members and families while serving as a liaison between the member, physician, hospital, and Plan. Ensure accurate, timely documentation into the EMR system every shift and evaluate employee performance through completed work assignments. Maintain current knowledge of evidence-based nursing practices to enhance business development and agency efficiency.