RN Case Manager, Inpatient Services (4-day schedule includes Saturday/Sunday) - Remote in Texas

About the position The RN Case Manager II - Inpatient Services is responsible for performing clinical reviews of inpatient admissions in various healthcare settings, including acute hospitals and skilled nursing facilities. This role involves implementing care plans, coordinating transitions to lower levels of care, and collaborating with interdisciplinary teams to ensure continuity of care for patients. The position supports a 4-day work week, including weekends, and emphasizes effective communication and documentation to meet organizational standards. Responsibilities • Collaborate with the Interdisciplinary Care Team (ICT) to establish individualized transition plans for members. , • Serve as the clinical liaison with hospital and administrative staff, performing clinical authorizations for inpatient care. , • Conduct expedited, standard, concurrent, and retrospective clinical reviews at various facilities. , • Document medical necessity and appropriate levels of care using recognized clinical guidelines. , • Communicate with facility staff, members, and families to assess discharge needs and formulate discharge plans. , • Identify member risk levels using Population Stratification tools and communicate transition plans with the ICT. , • Conduct transition discharge assessments to identify member needs at the time of transition. , • Manage assigned caseload efficiently using time management skills. , • Demonstrate knowledge of utilization management and care coordination processes for transition planning. , • Confer with UM Medical Directors regarding inpatient cases and participate in department huddles. , • Enter timely and accurate documentation into care management applications to comply with requirements. , • Adhere to organizational policies and procedures and take on-call assignments as directed. , • Maintain current licensure and hospital credentialing as required. , • Make decisions based on regulatory requirements and clinical guidelines. , • Monitor quality concerns regarding member care and report as per policy. Requirements • Bachelor's degree in Nursing or an Associate's degree in Nursing with 4+ years of relevant experience. , • Current, unrestricted RN license specific to the state of employment. , • Case Management Certification (CCM) or ability to obtain within 12 months after the first year of employment. , • 4+ years of diverse clinical experience with acutely ill patients. , • Knowledge of Microsoft Office applications including Outlook, Word, and Excel. , • Proven ability to read, analyze, and interpret medical records and health plan documents. , • Reliable transportation for travel to client and/or patient sites. , • Ability to work a 4-day work week including weekends from 8am - 6pm central time. Nice-to-haves • 3+ years of managed care and/or case management experience. , • Experience with psychiatric and geriatric patient populations. , • Knowledge of utilization management, quality improvement, and discharge planning. , • Bilingual (English/Spanish) proficiency. , • Proven problem-solving skills and ability to identify community resources. , • Strong critical thinking, nursing judgment, and decision-making skills. , • Ability to prioritize and manage multiple tasks effectively. , • Excellent planning, organizing, conflict resolution, and interpersonal skills. Benefits • Competitive salary and performance-based bonuses. , • Comprehensive health insurance plans. , • 401(k) retirement savings plan with company matching. , • Paid time off and paid holidays. , • Opportunities for professional development and continuing education. Apply Job!