Job Title: Registered Nurse (RN) Case Manager
Location: 1165 Montgomery Dr, Santa Rosa 95405
Shift: Day Shift, 5×8 Hours (08:00 AM – 04:30 PM)
Job Summary
We are seeking an experienced Registered Nurse (RN) Case Manager to join our team. The ideal candidate will have at least 2 years of acute hospital case management experience with a strong background in care coordination and discharge planning within a fast-paced hospital environment.
Required Qualifications
- Active RN License (California)
- Current BLS Certification
- Minimum 2 years of acute hospital case management experience
- Experience with care coordination and discharge planning
- Strong clinical assessment and communication skills
Key Responsibilities
- Coordinate patient care across the continuum of care
- Perform comprehensive needs assessments and develop individualized care plans
- Facilitate discharge planning and transitions of care
- Review admissions and determine medical necessity using evidence-based guidelines and InterQual criteria
- Manage utilization review and case management activities
- Coordinate benefits eligibility and prior authorizations
- Arrange Durable Medical Equipment (DME) and post-acute services as needed
- Collaborate with physicians, nurses, social workers, and interdisciplinary teams
- Support disease management and patient education initiatives
- Conduct data abstraction and documentation reviews
- Manage worker’s compensation and disability-related cases when applicable
Preferred Skills
- Case Management / Utilization Review
- Admission Criteria Review
- Care Coordination
- Discharge Planning
- Plan of Care Development
- Prior Authorization Processing
- InterQual Criteria Utilization
- Medical Necessity Determination
- Disease Management
- DME Coordination
- Benefits Eligibility Review
- Acute Hospital Experience
