RN Case Manager Acute Care

Position Overview

A 280+ bed acute care hospital is seeking an experienced RN Case Manager (Evenings) to join the Case Management team. In this role, you will coordinate interdisciplinary care, conduct utilization review, determine appropriate level of care, and support safe, timely discharges across ED, Med/Surg, Tele, Neuro, ICU, and PCU populations.

You will report directly to the Director of Case Management.

Key Responsibilities

• Complete comprehensive clinical and psychosocial assessments and develop criteria-based plans of care with clear discharge goals.

• Lead interdisciplinary huddles and collaborate closely with physicians, nursing, therapy, pharmacy, and social work.

• Conduct medical necessity reviews at admission and throughout hospitalization; escalate level-of-care issues as needed.

• Manage observation status appropriateness and convert to inpatient status when indicated.

• Perform concurrent/utilization reviews; document and communicate with third-party payers.

• Identify barriers to throughput; resolve issues to reduce LOS and prevent avoidable days and readmissions.

• Coordinate post-acute care services and connect patients/families with community resources.

• Document case management interventions and track/trend variances; contribute to performance improvement initiatives.

• Support compliance with regulatory standards and assist with staff education and protocol implementation.