Registered Nurse Case Manager- RN Clinical Access- MUST HAVE Utilization Review Experience

Clinical Access Case Manager - Registered Nurse (RN)

POSITION TYPE: Registered Nurse (RN)

SPECIALTY UNIT: Clinical Access Case Manager

LOCATION:

SHIFT:

JOB TYPE: Full-Time Permanent

Job Summary:

We are seeking a passionate and dedicated Clinical Access Case Manager - Registered Nurse (RN). As a Clinical Access Case Manager you will be responsible for assessing patients’ needs, coordinating care, and ensuring timely access to medical services. This role involves collaboration with healthcare providers, insurance companies, and patients to optimize health outcomes and enhance the patient experience.

Responsibilities:

• Assess patient needs and coordinate care plans to ensure timely access to appropriate medical services.
• Act as a liaison between patients, healthcare providers, and insurance companies to facilitate smooth access to care.
• Evaluate and verify insurance coverage, pre-authorizations, and eligibility for services.
• Educate patients and families about healthcare services, insurance benefits, and available resources.
• Monitor and follow up on patient progress to ensure adherence to treatment plans and identify potential barriers to care.
• Maintain accurate and up-to-date patient records and documentation in compliance with healthcare regulations.
• Collaborate with interdisciplinary teams to develop and implement care strategies.
• Stay informed about healthcare regulations, policies, and best practices to improve patient access and outcomes.

Job Benefits:

• Competitive salary
• Direct Deposit
• 401K
• Comprehensive Health, Dental, and Vision benefits
• Employee discount program
• Excellent room for growth and advancement

Requirements:

• Current and valid Registered Nurse (RN) license within State of practice.
• Bachelor’s degree in Nursing (BSN); Master’s degree in Nursing (MSN) preferred.
• Minimum of 2+ years of experience in acute care and case management.
• Basic Life Support (BLS) Certification required.
• Experience working with insurance processes, pre-authorizations, and patient advocacy.
• Strong knowledge of healthcare systems, regulations, and access management.
• Excellent communication, organizational, and problem-solving skills.
• Ability to work independently and collaboratively within a multidisciplinary team.

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