RN Case Manager
Required skills
- Registered Nurse
- RN
- Clinical Experience
- CMS
- Commercial Insurance
- Medicare
- Medicaid
- Third Party Payer Contracts
- Microsoft Word
- Microsoft Excel
Nice to have
- BSN
- Home Health Care
- Skilled Nursing Industry
- RN Case Management
Role summary
PruittHealth is seeking a Registered Nurse (RN) Case Manager to ensure medically necessary services for patients post-acute care. This role requires understanding of post-acute services, case management, and the continuum of care. The RN Case Manager must be knowledgeable of CMS and Commercial Insurance requirements, including medical necessity review guidelines for commercial, Medicare, and Medicaid products. Proficiency in computer applications, Microsoft Word, intermediate Excel, and Outlook is essential. Strong organizational and multitasking abilities are key to success. A minimum of 3 years of clinical experience is required, with home health care, skilled nursing, or RN Case Management experience being highly preferred. A BSN is preferred, and a current RN license in GA is mandatory.
POSITION SUMMARY:
Ensures the continuation of medically necessary services to our patients post -acute care. Demonstrates understanding of post-acute services and case management as it relates to the continuum of care.
ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES:
• Demonstrates the ability to understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards.
• Must be knowledgeable of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products.
• Uses knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts.
• Demonstrates the ability to communicate effectively via phone and email with our internal and external customers.
• Strong organization and ability to multi task is essential to success in this role.
LICENSURE, CERTIFICATION, EXPERIENCE AND EDUCATION REQUIREMENTS:
• BSN preferred
• Currently licensed Registered Nurse in the state of GA.
• A minimum of 3-years of clinical experience is required.
• Home Health Care and or skilled nursing industry experience highly preferred.
• RN Case Management experience preferred.
• Must be proficient in the use of computer applications for daily use.
• Highly proficient in Microsoft Word, Intermediate Excel and Outlook required
Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.
We are eager to connect with you! Apply Now to get started at PruittHealth!
As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.
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For more information regarding Florida’s Care Provider Background Screening Clearinghouse Education and Awareness, please visit https://info.flclearinghouse.com
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