RN Case Manager

• Participates in utilization management, discharge planning, patient throughput, and evaluates the appropriate use of hospital resources by ensuring that patients meet medical necessity during their hospitalization

• Utilizes the organizational approved references and software programs to assess medical necessity

• Responsible for managing payer relations and requirements to achieve optimum reimbursement and patient outcomes

• Reviews documentation for quality assurance and clinical validation

• Ensures CMS discharge standards are achieved

• Provides case management in collaboration with the medical staff, nursing, and ancillary departments throughout the hospital to ensure a safe, timely, transition to the appropriate level of care

• Familiar with standard concepts, practices, and procedures within the field

• Relies on experience and judgment to plan and accomplish goals

• Regular and predictable attendance is an essential job function

• Competent to meet age specific needs of the unit assigned

• State of Idaho Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with Idaho

• Licensed RN with a minimum 3 years’ patient-facing RN experience at time of hire, ADN or diploma required; BSN or higher preferred.

• Licensed RN's with less than 3 years’ patient-facing RN experience as an ADN at time of hire are required to be enrolled in a baccalaureate (or higher) degree program in nursing within 1 year of employment, with BSN completion within 3 years of hire

• Minimum 3 years clinical practice experience required

• Previous utilization review experience preferred

• Current Certified Case Manager (CCM) certification, American Case Management (ACMA) certification, Certified Professional Utilization Review (CPUR) or Case Management Administration Certification (CMAC) preferred

• Excellent communication, organizational and interpersonal skills. Ability to work independently and manage time and decisions

• Proficiency with standard software applications including spreadsheets and word processing required. Experience using Interqual preferred

• Knowledge of healthcare law and regulations related to acute care and the immediate post-acute continuum preferred

• Must be able to maintain a standing and/or sitting position

• Typical equipment used in an office job

• Repetitive movements

• If you change your title or department, you will receive a new badge. Badges are printed and available in Security on the Wednesday of the week following your transfer.
• Your benefits may change if your position status (FT, PT, or PRN) has been updated. Please talk with your Recruiter if you have any questions about your status and benefits.
• Those with a primary position as a PRN will receive per diem pay. Per Diem rates are tiered depending on number of years of employment.
• If you are moving into a new role, HR will provide you with a new job description to review and sign. HR will also request documentation for any new requirements for your position, including experience, education, licensure, certification, etc.
• If EPIC training is required for your role and you have not completed the required module for your position, please complete an EPIC Fast Track Attestation at
• If an advanced background check with Health and Welfare is required for your role and you have not completed one previously, you will need to complete the process before your transfer date.

Kootenai Health