**RN Case Manager I


All nursing practice is based on the legal scope of practice, ***** and specialty nursing standards, ***** ***** Policies and Procedures, and in accordance with all applicable laws and regulations. The Professional Model of Care requires registered professional nurses to be responsible and accountable for their own practice. ***** ***** supports the development of RN relationships within the community; specifically those relationships associated with the health and well being of the community at large.

Roles Responsibility
Participate in Shared Leadership, Contribute to the MAGNET Journey of ***** *****, Ensure that nursing practice is based on evidence of best practice, Accountable for participating in the Nursing Division’s Performance Improvement process (division or unit level), Participate in community activities, Conduct timely clinical reviews drawing upon appropriate resources and apply *****ly recognized criteria to support medical necessity of patient observation admission or inpatient admission and continued hospitalization, Address treatment delay, potential and actual denials with the Attending physician and other relevant members of the healthcare team, Provide clinical reviews to third party payers and validates authorization or denial of services from them, Document approved and denied services in STAR to facilitate meaningful data analysis, Communicate verbally and/or written e.g., email) with payers and healthcare team in a clear, timely, accurate and professional manner and/or organized in a professional format, Speak up when team members appear to exhibit unsafe behavior or performance, Continuously validate and verify information needed for decision making or documentation, Stop in the face of uncertainty and takes time to resolve the situation, Demonstrate accurate, clear and timely verbal and written communication, Actively promote safety for patients, families, visitors and co-workers, Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance
Desired Qualification
Bachelor of Science in Nursing, Utilization Management, Clinical Nursing
Full Time
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