Travel Nurse RN - Case Management
Poplar, MT
Encode INC
5x8 hrs, Days
Referral Bonus

JOB TITLE: Registered Nurse (RN) – Nurse Case Manager (PRC)

LOCATIONS:
• Verne E. Gibbs Health Center – Poplar, MT
• Chief Redstone Health Center – Wolf Point, MT

CONTRACT TERM:
• 12-Month Assignment
• 2,080 Hours (1.0 FTE)

SCHEDULE:
• Monday – Friday
• 8:00 AM – 4:30 PM (Local Time)
• Excluding Federal Holidays
• Schedule coordinated with the PRC Supervisor

POSITION SUMMARY:
The Nurse Case Manager (PRC) is responsible for providing comprehensive case management and care coordination services for patients with special healthcare needs. The RN collaborates with providers, Purchased/Referred Care (PRC) staff, and external healthcare facilities to ensure medically necessary, cost-effective, and appropriate healthcare services while promoting continuity of care and positive patient outcomes.

ESSENTIAL RESPONSIBILITIES:
• Provide specialized case management services and coordinate care for patients with complex and special healthcare needs.
• Review and monitor outpatient consultations and referrals for medical necessity, appropriateness, and cost-effectiveness.
• Coordinate referrals and follow-up services with healthcare providers, specialists, hospitals, and external facilities.
• Collaborate with PRC staff and interdisciplinary teams to ensure care aligns with CMS guidelines and organizational requirements.
• Monitor and track patient referrals, authorizations, and deferred consults to ensure timely access to care.
• Maintain accurate statistical data, reports, and documentation related to consults, referrals, and case management activities.
• Facilitate continuity of care and advocate for patient needs throughout the referral and treatment process.
• Participate in quality improvement initiatives and support the continuous improvement of PRC processes and outcomes.
• Maintain accurate and timely documentation in accordance with organizational, state, and federal regulations.
• Ensure compliance with HIPAA, confidentiality standards, and all applicable policies and procedures.
• Communicate effectively with patients, families, providers, and external healthcare organizations regarding treatment plans and referral status.
• Participate in departmental meetings, training programs, and professional development activities.
• Perform additional duties and responsibilities as assigned.

MINIMUM QUALIFICATIONS:
• Graduate of an accredited Registered Nursing program.
• Current, active, and unrestricted Registered Nurse (RN) license.
• Minimum of three (3) years of recent Registered Nurse experience preferred.
• Previous Case Management and/or Purchased/Referred Care (PRC) experience preferred.
• Experience in utilization review, care coordination, discharge planning, or community health nursing preferred.

KNOWLEDGE, SKILLS, AND ABILITIES:
• Strong knowledge of case management principles and care coordination practices.
• Knowledge of CMS guidelines, medical necessity criteria, and utilization review processes.
• Excellent assessment, critical-thinking, and problem-solving skills.
• Strong organizational and time-management abilities.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively within a multidisciplinary healthcare team.
• Proficiency with electronic health records and healthcare documentation systems.
• Strong patient advocacy and customer service skills.

ADDITIONAL REQUIREMENTS:
• Must comply with all federal contract requirements, including HIPAA, PPE, background checks, computer security, documentation standards, and professional appearance requirements.
• Overtime must be pre-approved by the COR or Service Unit TPOC and appropriately documented.
• Must maintain accurate logs of hours worked and support continuous service coverage as required by the facility.