Description
Step into a meaningful role at Logan Regional Medical Center, a 132-bed facility located in southern West Virginia. Logan Regional is an award-winning, full-service community hospital with a history of innovation, from its one-of-a-kind Rural General Surgery residency program to its collaboration with Marshall Health Network to bring more opportunities for specialty care to the area. Logan Regional has earned the prestigious 'A' grade from The Leapfrog Group, inclusion in Becker’s listing of Great Community Hospitals, Forbes Inaugural Top Hospitals list, and Best-in-State hospital status from Newsweek/Statista. Consider growing your career at Logan Regional, which offers an ideal combination of high standards of care in a small, caring community.
Job Summary
The RN–Case Manager is responsible for assessing, planning, coordinating, and monitoring the healthcare services and resources necessary to meet the individual needs of patients. This role ensures effective case management processes that promote optimal patient outcomes, quality of care, regulatory compliance, and cost efficiency across the continuum of care.
Essential Functions
- Reviews clinical documentation and coordinates care across departments to ensure medically necessary services are provided in a timely and cost-effective manner
- Performs discharge planning by identifying patient needs and arranging post-discharge services including home health, medical equipment, and rehabilitation
- Collaborates with interdisciplinary team members, physicians, patients, and families to support quality care and safe transitions
- Communicates with insurance providers and payers for authorization and continued stay approvals
- Documents all activities, decisions, communications, and patient education in the EMR
- Participates in performance improvement initiatives, utilization review, and data collection efforts for administrative reporting
- Conducts 48-hour post-discharge follow-up calls as applicable
- Advocates for the patient and serves as a liaison between healthcare providers, patients, families, and community resources
- Assists with readmission assessments and care coordination strategies
- Keeps current with Medicare/Medicaid rules, CMS guidelines, and payer requirements
Knowledge/Skills/Abilities/Expectations
- Advanced understanding of case management principles, patient advocacy, and discharge planning
- Strong critical thinking, time management, and problem-solving skills
- Excellent interpersonal and communication abilities
- Familiarity with utilization management, payer authorization processes, and EMR systems
- Capacity to work independently and collaboratively in a high-pressure environment
- Commitment to maintaining patient confidentiality and upholding ethical standards
- Ability to prioritize multiple responsibilities and adjust to changes in work schedule or patient needs
Qualifications
Education
- Associate Degree in Nursing, required
- Bachelor of Science in Nursing (BSN), preferred
Licenses/Certifications
- Current and valid Registered Nurse license in the state of practice or Compact State RN license
- Basic Life Support (BLS) – required within time frame specified in facility policy
- Accredited Case Manager (ACM) Certification as required by facility policy
Experience
- Minimum of 1-2 years of clinical experience in an acute hospital, clinic, home health, hospice, or mental health facility, required
- Previous case management experience preferred