At Peak, we recognize the training and experience that goes into becoming an experienced Case Manager. We know that deep down, helping patients emerge successfully from their inpatient stays isn't just a project for good case managers—it's a rewarding career. Our employees have a unique opportunity to work for some of the nation's top hospitals including teaching facilities and high-acuity level sites.
We provide ongoing training to ensure our employees receive regulatory updates, information on new procedures and guidance on current trends.
An RN Case Manager must be able to multitask and handle numerous responsibilities throughout each
day. They must also be effective communicators with patients, families, doctors, and insurance providers; capable of understanding and explaining the features of Medicare, Medicaid, and other insurance options. In-depth knowledge of health care services and medical terminology is a requirement as well.
PCRM (case manager) to complete assessment, discharge planning and utilization review on every patient. These individuals are part of the medical team and round with the MD’s and CNP/PA teams every day. The PCRM assures that the medical team is aware of all barriers to preferred discharge plan and works with payers, teams and patients to remove and manage the barriers. The PCRM follows all regulatory guidelines from CMS and ensures that the Attending MD’s are aware of any issues. The PCRM partners with Social Work colleagues to transition patients to SNF’s or Hospice. In addition, the PCRM’s collect data on every readmission to the James Cancer Hospital. The PCRM enters and updates the estimated discharge date on every patient in the James. The general caseload for each PCRM is 12-15 patients, but this varies by service and is typically an even lower ratio. The lower case ratio allows the case manager to ensure a safe discharge plan, and focus on ensuring that the payers are covering all of the stays. The PCRM’s schedule all follow up appointments, and completes the discharge paperwork for the patients. The PCRM’s make referrals to post-acute providers, as needed and facilitate care along the continuum.
BSN, Experience in case management or strong clinical knowledge of Oncology population, Working knowledge of MCG –evidence based care guidelines utilized in utilization review, experience of dual aspects of role—UR and discharge planning, ability to adapt to new work environment, working knowledge of ACMA scope of practice, excellent communication skills, ability to prioritize patient, service and hospital needs in order to complete daily workload in a timely manner
MSN, Oncology Experience, 3-5 years nursing experience, case management certification, working knowledge of third party payers and CMS guidelines, familiarity with prior authorization for high cost medication.
Peak Health Solutions, an AMN Healthcare company, is an EEO/AA/Disability/Protected Veteran Employer. We encourage minority and female applicants to apply