Invested

The RN CASE MANAGER provides ongoing support to Mayo Clinic Rochester and Mayo Clinic Health System medical practices with direct interaction with clinical staff in the hospital setting, including nursing, social workers, physicians and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review, including concurrent admission status and continued stay clinical review; communication with clinical providers to identify quality value based purchasing core measures for hospital bedded patients. Clarification and face to face education to clinical staff regarding quality metrics, and continued admission status review to ensure accurate clinical documentation to support the care provided.  This position requires strong independent decision making, assessment, and reasoning while determining the appropriateness of patient admission status following established admission criteria and regulations. This position requires knowledge, understanding, and continued education on current regulatory compliance requirements of Government Payers in relation to Admission Status, Clinical Documentation, and Value Based Purchasing. THE RN CASE MANAGER communicates with physicians, patients, and other clinical staff regarding documentation, Quality, and Admission Status criteria and regulatory requirements and penalties. The RN CASE MANAGER works with Third-Party and Government payers to meet managed care and continued stay requirements. The RN Case Manager participates with interdisciplinary, inpatient-hospital rounds and collaborates to potentially impact length of stay. 

Graduate of an accredited baccalaureate nursing program (BSN), as recognized by the Accreditation Commission for Education in Nursing (ACEN), Commission on Collegiate Nursing Education (CCNE), National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

Additional Qualifications :

Previous medical denial experience preferred. Exceptional attention to detail, critical thinking, verbal and written communication, and writing skills are required. Must have in-depth understanding of anatomy, physiology medical terminology and disease processes. Knowledge of CPT coding, resource management systems, electronic medical record and personal computers beneficial. Demonstrated leadership, independent problem solving, conflict resolution, critical thinking skills, and team building skills required. Must be self-motivated and able to work as part of a team with minimal supervision. Must possess the ability to work well within a creative and challenging work environment. Experience in utilization review, ability to navigate medical records, value based purchasing metrics, or pre-certification helpful. Additional nursing experience in specialty area beneficial. Certification in Case Management preferred.

Internal applicants are required to attach their three most recent performance appraisals.

License or Certification :

Current RN license by applicable state requirements.

Basic Cardiac Life Support for healthcare providers- BCLS – certificate of course completion required and must not expire within 3 months after start date.  A scanned copy of the certificate of completion or transcripts, including your full name, must be attached to your profile to be considered.

We will only accept certificates of course completion from the following providers:

• American Heart Association (Title: BLS for Healthcare Providers or BLS Provider)
• Red Cross (Title: CPR/AED for Professional Rescuers and Health Care Providers or BLS for Healthcare Providers)
• Military Training Network

Additional specialty certification/training as required by the work area.