Nurse Case Manager

Under the general supervision of the Manager, nurses in the Case Manager role provide clinically-based case management to support the delivery of effective and efficient patient care. Paces cases from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned caseload. Partners with Social Workers and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement.

This position is Full-time, 8am-4:30pm with rotating weekends and Holidays

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Determines medical necessity, appropriateness of admission, continuing stay and level of care.

2. Validates admission and continuing stay criteria with third party payers as well as Physicians.

3. Collaborates with the third party payers to anticipate denial of payment and proactively.

4. Supports the effective prevention and management of denials, including drafting appeal letters.

5. Assess the patient and family for continuing care needs to develop, implement and evaluate discharge plan.

6. Actively contributes to, participates in, and follows through on interventions identified in care coordination.

8. Identifies high risk patients and creates a collaborative plan to address their unique needs.

Community First Medical Center offers benefits to all its full-time and part-time employees:United Healthcare Medical PPO/HMO Plans| MetLife Dental |MetLife Vision| 6 Paid Holidays | Paid Time Off | Company Paid Short-term & Long-term Disability | Company Paid Life Insurance | 401(k) | Voluntary Benefits: Hospital Indemnity & Critical Illness

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

Education and Experience:

• Associate’s degree in Nursing required, Bachelors degree preferred
• Current Illinois RN Licensure
• 3 to 5 years experience in acute care required,
• 2 years experience as a Case Manager in an acute care setting preferred
• Experience with Midas strongly preferred

Community First Medical Center is an affirmative action/equal opportunity employer who is committed to cultivating diversity, equity and inclusion within all aspects of our organizations. We stand against and prohibit discrimination in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.