Job Description

Position: Registered Nurse – Case Manager Location: Gainesville, Florida Employment Type: Full-Time, Regular

Overview: A leading healthcare provider in Gainesville is seeking a skilled and proactive RN Case Manager to support interdisciplinary care planning and ensure optimal patient outcomes. This role involves evaluating medical necessity, admission status, and discharge readiness while coordinating resources across the care continuum.

Key Responsibilities:

• Conduct initial and ongoing patient assessments to support appropriate level of care planning.
• Review admission and preoperative documentation to ensure completeness and alignment with protocols.
• Collaborate with physician offices to secure necessary evaluations prior to admission, surgery, or procedures.
• Incorporate patients and families into care facilitation and education efforts.
• Participate in the development of critical pathways and utilize support tools to identify length-of-stay outliers.
• Educate physicians, patients, and families on benefit plans and their clinical and financial implications.
• Manage payer denials and issue hospital-initiated notices of non-coverage when necessary.
• Coordinate care transitions across various delivery systems and levels of care.
• Define target clinical outcomes, set service timelines, and plan care to address holistic patient needs.
• Join interdisciplinary team rounds and contribute to utilization review activities.
• Ensure timely submission of documentation and authorization requests to insurance providers.
• Apply clinical review criteria (e.g. Interqual) and maintain up-to-date records using MIDAS.
• Cross-train to function across case management areas and facilitate appropriate care delivery alternatives.
• Assist with patient education and tailor communication to learning preferences, cultural factors, and comprehension levels.
• Document teaching episodes and verify patient/family understanding of discharge instructions.

Qualifications:

• Recent (within the past year) acute care case management experience required; candidates with 2–3 years of ICU or strong Med-Surg experience may be considered.
• LTAC case management experience also acceptable.
• Demonstrated critical thinking and clinical knowledge essential for patient care planning.
• Certification in Case Management, Nursing, or Utilization Review preferred.
• Active Florida RN license or multistate compact license (compact holders must obtain Florida license within 60 days of relocation).
• BLS (AHA Healthcare Provider) certification required within 30 days of employment.
• Minimum of 3 years RN experience in an acute care setting.
• Graduate of an accredited nursing program; BSN preferred.

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