Case manager - registered nurse

The Case Manager coordinates admissions, discharge planning, and case management services. This role oversees the patient vetting and registration process, including gathering and validating information, coordinating approvals with billing for payer source, pharmacy for medication review, and the provider for patient acceptance. The Case Manager also conducts initial and ongoing patient assessments, connects patients with appropriate resources, and makes referrals as needed. The role serves as a liaison among patients, families, and healthcare professionals to support clear communication and continuity of care.

ESSENTIAL FUNCTIONS:

• Coordinate the admissions and discharge planning and respond to public and patient admission inquiries.
• Manage admissions in line with the hospital's mission and procedures by collecting required information, obtaining approvals, and initiating pre-registration.
• Notify relevant departments of admissions and complete required system reporting.
• Coordinate utilization management, including inpatient reviews and appeals, through initial and ongoing clinical assessment, documentation, and interpretation of medical records in collaboration with the Medical Director.
• Distribute and explain the Notice of Medicare Non-Coverage (NOMNC) to Medicare patients and evaluate acute patients to determine medical necessity and level of care.
• Provide case management services and collaborate with patients, physicians, and other healthcare providers to support clinical, operational, and financial outcomes.
• Assess patient needs, determine appropriate disposition, arrange referrals and coordinate services such as, durable medical equipment (DME), home health, long-term care, transportation, and follow-up appointments.
• Monitor patient progress throughout the hospital stays, work with agencies and service providers, and support patients and families in making informed decisions.
• Develop and maintain effective working relationships with physicians and interdisciplinary team members while supporting needed policies and procedures.
• Adhere to professional standards, hospital policies and procedures, and applicable federal, state, and local requirements.

ADDITIONAL RESPONSIBILITES:

Other duties as assigned by the Assistant Chief Nursing Officer.

JOB QUALIFICATIONS/EXPERIENCE/SKILLS:

REQUIRED:

• Current state of Hawaii Registered Nurse License.
• Five years of related experience in a hospital setting.
• Knowledge of insurance verification and healthcare regulations.
• Strong organizational, communication, and multitasking skills.
• Knowledge of community resources, and critical thinking skills.
• Proficiency with electronic health records (EHR) systems.

PREFERRED:

• Hospital Case Management experience.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Prolonged sitting with frequent standing, walking, occasional climbing or balancing, stooping, kneeling, crouching, and crawling. Pushing, pulling, lifting, and carrying up to 10 lbs. Potential exposure to infectious diseases, biohazards, and varying noise levels. Working in a demanding environment. Exposure to sensitive and confidential information.

DISCLAIMER:

This job description may not comprise all duties that may be required to be performed. Management reserves the right to amend as needed.