Case Management RN
Eureka, CA
Prodware Health
5x8 hrs, Days

Job Summary

Seeking an experienced Acute Care Hospital Case Manager to coordinate patient care, manage discharge planning, and ensure appropriate utilization of healthcare resources. The ideal candidate will have strong acute hospital case management experience, excellent interdisciplinary communication skills, and knowledge of healthcare regulations and insurance processes.

Key Responsibilities

• Coordinate patient care and discharge planning across acute hospital units.
• Conduct comprehensive patient assessments and identify post-discharge needs.
• Collaborate with physicians, nurses, social workers, and interdisciplinary teams to ensure continuity of care.
• Arrange post-acute services, durable medical equipment (DME), and community resources.
• Manage utilization review, admission criteria, insurance authorizations, appeals, and denials.
• Coordinate care involving HMOs, IPAs, and other managed care organizations.
• Assist with advance directives, POLST documentation, and protective services processes.
• Ensure compliance with CMS regulations, HIPAA, and Joint Commission standards.
• Maintain accurate documentation using Epic.

Required Qualifications

• Minimum 2 years of acute hospital Case Management experience, including care coordination and discharge planning.
• Must have acute care hospital Case Management experience within the last 12 months.
• Experience with Case Management and Utilization Review in an acute hospital setting.
• Proficiency with the Epic electronic health record system.
• Experience working with HMOs, IPAs, and insurance benefit eligibility.
• Knowledge of advance directives, POLST, and protective services processes.
• Familiarity with CMS guidelines, HIPAA, admission criteria, and discharge planning requirements.
• Experience coordinating care across hospital departments, including ICU, Emergency Department, Medical-Surgical, Pediatrics, and Stepdown/PCU settings.