Job Description

Job Title: Nurse Case Manager

Location: On Site - Lanham, Maryland, United States

Salary: $75,000-$100,000

Skills: Care Coordination, Case Management, Clinical Assessment, Patient Advocacy, Regulatory Compliance

About the Company / Opportunity:

Join a leading organization in the hospitals and health care industry, dedicated to delivering high-quality, patient-centered care. This is an opportunity to make a significant impact on the lives of patients by supporting them through complex healthcare journeys. As a Nurse Case Manager, you will collaborate with a multidisciplinary team to ensure safe and effective transitions across the continuum of care, while promoting optimal health outcomes and resource utilization.

Responsibilities:

• Identify and prioritize patients in need of care management services using a holistic, multidisciplinary approach.
• Promote patient engagement, self-care, and treatment adherence through strategies such as motivational interviewing.
• Utilize evidence-based guidelines to verify appropriate level of care, ensure quality, and decrease unnecessary variation.
• Manage observation stay patients to facilitate timely testing, treatment, and appropriate transitions.
• Develop and coordinate comprehensive transition plans to home, community programs, or post-acute care providers, ensuring clear documentation and handovers.
• Maintain accurate, concise documentation of patient needs, care plans, and support systems in the medical record.
• Participate in clinical outcome projects and process improvement initiatives within the care management department.
• Initiate and coordinate referrals to members of the healthcare team as needed, ensuring ongoing plan of care adjustments and leadership communication.
• Apply risk and predictive analytics to identify factors affecting readmission and implement tailored interventions to support optimal patient outcomes.
• Maintain compliance with all regulatory standards, including CMS and commercial insurers.

Must-Have Skills:

• Current licensure as a registered nurse by the Maryland Board of Nursing.
• BSN or ADN with equivalent experience, with BSN required within 5 years of start date.
• Minimum of three years’ experience in a clinical, ambulatory, or post-acute care setting.
• Expertise in case management, care coordination, and interdisciplinary collaboration.
• Strong documentation and communication skills.

Nice-to-Have Skills:

• Care coordination experience in a hospital or similar environment.
• Experience with evidence-based guideline tools such as InterQual.
• Familiarity with Epic or other electronic health record (EHR) systems.
• Knowledge of regulatory requirements for Medicare, Medicaid, and commercial insurers.
• Participation in quality improvement or clinical outcome projects.

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