Inpatient Case Manager (LVN or RN)

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

Key Responsibilities

• Comply with Case Management Department policies and procedures
• Achieve 95-100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize Milliman Care Guidelines criteria for transition of care, skilled nursing needs, and acute rehabilitation placement recommendations
• Collaborate with hospitalists, case managers, and discharge planners to establish discharge plans upon admission
• Coordinate initial and concurrent reviews through medical record review and provide accurate daily inpatient admission reporting to leadership
• Review medical records and supporting documentation to determine medical necessity, appropriateness, and level of care
• Assess, plan, implement, coordinate, monitor, and evaluate services with the goal of reducing hospital readmissions
• Attend and coordinate case management meetings on-site and off-site as required
• Communicate determination outcomes to providers and members in accordance with regulatory and accreditation requirements
• Respond to provider and interdepartmental inquiries while demonstrating exceptional customer service
• Maintain productive relationships with health plans, hospitals, and medical directors and assist with issue resolution
• Report daily activities, trends, and concerns to Case Management leadership

Skills, Knowledge & Expertise

• Active Rhode Island RN license or active Rhode Island LVN license
• At least 2 years of clinical nursing experience
• Ability to commute to the Johnston, Rhode Island office
• Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook
• Strong analytical and critical reasoning skills
• Ability to prioritize multiple responsibilities in a fast-paced environment while meeting deadlines
• Ability to educate and train staff and cross-functional departments
• Strong communication, relationship-building, and customer service skills

• Previous case management experience
• Experience using EZCAP
• Experience working with utilization management or care coordination programs
• Familiarity with transition of care and discharge planning processes

• Active Rhode Island RN license or active Rhode Island LVN license

Benefits

• Full-time position located in Johnston, Rhode Island
• Standard day schedule, Monday through Friday
• Frequent use of a computer, telephone, and standard office equipment
• Ability to work in a fast-paced environment while managing multiple priorities and deadlines
• Occasional travel to on-site and off-site meetings as needed