Case Management Nurse

RN Care Management Coordinator – Infusion Therapy Team (Remote) Department: Care Management and Coordination Employment Type: Full-Time | Location: Remote Join a team that’s making a real impact on patients' lives. We are currently seeking a Registered Nurse (RN) Care Management Coordinator to support our Infusion Therapy Team. This remote position offers the opportunity to play a pivotal role in optimizing healthcare outcomes through strategic care coordination and utilization review. About the Role: Under the guidance of the Care Management and Coordination Supervisor, the RN Care Management Coordinator performs telephonic or onsite reviews of hospital admissions, ensures appropriate utilization of healthcare resources, and facilitates early and effective discharge planning. This role is key to driving quality care, promoting efficient use of services, and enhancing patient outcomes.

Conduct utilization management reviews for inpatient admissions (onsite or remote). Assess the need for inpatient care, continued stay, and appropriate length of stay using medical criteria software. Coordinate care transitions to the most appropriate, cost-effective settings without compromising quality. Collaborate with attending physicians to review treatment plans and clarify medical necessity. Identify hospital admissions that no longer meet inpatient criteria and present cases to Medical Directors as needed. Evaluate members for discharge planning needs early in their hospital stay. Work with hospital staff, physicians, and families to facilitate smooth, timely discharges. Identify cases for case management or disease management referrals. Flag quality-of-care concerns and report them to the appropriate departments. Maintain accurate and timely documentation in internal systems. Comply with state, federal, and accreditation standards in all utilization decisions. Support provider education and build positive relationships across the healthcare network. Report trends, utilization issues, and improvement opportunities to leadership.