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Parma, OH

RN Case Manager

$55,000-$81,000 / YEAR
RN Case Manager - Grace Hospital System - Cleveland, OH

Acute Long-Term Care Hospital
An exciting opportunity in a professional hospital setting assisting patients transition to inpatient rehabilitation, skilled nursing, and home care. Grace Hospital is a not-for-profit registered Acute Long-Term Care Hospital, the first of its kind to be established in Cuyahoga County. We are Medicare and Medicaid certified and fully accredited by the Joint Commission. Grace Hospital utilizes an interdisciplinary care team model to produce optimal clinical outcomes. We seek care-givers who are compassionate, competent, and results-oriented to join our team.

RN Case Manager Position Overview:
  • Ensures authorization number with admission approval form third party payers and managed care providers.
  • In concert with the physician and the interdisciplinary team, formulates a plan of care to guide patient from admission to continued care beyond the hospital environment.
  • Performs admission and concurrent utilization review all patients based on continued stay criteria.
  • Prepares and presents outlier reports as directed
  • Facilitates interdisciplinary team conference to develop and evaluate a plan of care or the patient.
  • Participates in patient care rounds with physician and members of the interdisciplinary team.
  • Assists physician in fully documenting the plan of care.
  • Facilitates measures to prevent variances from plan of care and over/under utilization or resources (i.e. lab and x- ray studies as ordered) by working closely with physicians and Medical Director(s).
  • During the patient’s hospital stay, communicates information to third party payers and managed care organizations to obtain approval for continued stay; as necessary communicates information from third party/managed care review to the physician managing patient’s care;  pre-certifies secondary insurance when applicable; applies for Medicaid when necessary.
  • Works closely with the Case Managers of third party payers and managed care organizations to ensure the plan for discharge meets the patient’s needs and is within the approved networks.
  • Serves as a liaison with fiscal services in providing financial tracking for the patient population: i.e. remaining Medicare days, changes in insurance coverage, etc.
  • Serves as a counselor to patients and family members about financial and insurance coverage.
  • In a timely manner, provides information and works closely with the Manager, Social Services to expedite the insurance appeal process for denials.
RN Case Manager Position Qualifications:
  • Graduated from an accredited school of nursing.
  • Three to five years experience in an acute/sub acute setting with involvement in case management, utilization review, utilization management, and discharge planning.
  • Licensed as a Registered Nurse in the State of Ohio; certificate in Case Management preferred.