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nurse case manager

Nurse Case Manager Job Description

Review this Nurse Case Manager job description for a reference when building your resume. Review the qualifications and requirements listed to get an understanding of what you need to include on your resume for what employers would look for in this field.

SUMMARY:

A Nurse Case Manager is a registered nurse with specialized training in coordinating and managing healthcare services for patients across the continuum of care. Working in hospitals, clinics, insurance companies, or community health organizations, Nurse Case Managers play a vital role in ensuring seamless and efficient healthcare delivery while advocating for the best interests of the patient.

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FUNCTIONAL DUTIES:

  1. Patient Assessment:
    • Conduct comprehensive assessments of patients’ health status, medical history, and treatment needs.
    • Identify potential risks, barriers to care, and social determinants of health.
  2. Care Planning:
    • Develop individualized care plans in collaboration with patients, families, and the healthcare team.
    • Establish goals and interventions to achieve optimal patient outcomes.
  3. Coordination of Care:
    • Coordinate and facilitate the delivery of healthcare services across various providers and settings.
    • Ensure effective communication and collaboration among healthcare team members.
  4. Utilization Review:
    • Conduct utilization reviews to evaluate the appropriateness and necessity of medical services.
    • Advocate for cost-effective and quality care.
  5. Patient Advocacy:
    • Advocate for patients’ needs and preferences within the healthcare system.
    • Assist patients in navigating the complexities of the healthcare system.
  6. Resource Management:
    • Assess and coordinate the use of healthcare resources, including durable medical equipment, home health services, and community resources.
    • Optimize resource utilization while meeting patient needs.
  7. Educational Support:
    • Provide education to patients and families regarding their health conditions, treatment plans, and self-management strategies.
    • Promote health literacy and shared decision-making.
  8. Discharge Planning:
    • Develop and implement safe and effective discharge plans.
    • Ensure continuity of care and appropriate follow-up after hospitalization.
  9. Collaboration with Providers:
    • Collaborate with physicians, specialists, therapists, and other healthcare providers to enhance care coordination.
    • Participate in multidisciplinary care teams.
  10. Documentation:
    • Maintain accurate and up-to-date electronic health records (EHR) for all case management activities.
    • Document assessments, interventions, and communication with patients and providers.

REQUIREMENTS:

  • Bachelor’s degree in Nursing (BSN) is preferred; Associate Degree in Nursing (ADN) accepted.
  • Current and unrestricted Registered Nurse (RN) license.
  • Certification in Case Management (CCM) or relevant specialty (optional but preferred).
  • Strong clinical assessment and communication skills.
  • Knowledge of healthcare reimbursement and insurance processes.
  • Familiarity with regulatory requirements and accreditation standards.
  • Ability to use technology for electronic documentation and communication.
  • Commitment to patient-centered care and advocacy.

Note: Nurse Case Manager job descriptions may vary based on the specific requirements of the healthcare facility, insurance company, or community health organization.

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