Case Manager RN

Case Manager RN
Location: Gainesville, FL
Job Type: Full-Time

Available Shifts:

• Day Shift: 8:00 AM - 4:30 PM (Rotating Weekends)
• Evening Shift: 12:00 PM - 8:30 PM (Alternative: 11:00 AM - 7:30 PM, Monday - Friday, No Weekends)

Role Overview:

The Case Manager RN will be responsible for conducting patient assessments, coordinating care, and managing utilization review to ensure optimal patient outcomes. The role requires strong critical thinking skills, multitasking abilities, and effective communication with healthcare teams and patients.

Key Responsibilities:

• Conduct initial and ongoing patient assessments related to clinical condition, level of care, and care plans.
• Review admission and pre-op orders to ensure all necessary components are met.
• Assist physician offices in obtaining necessary assessments before surgeries, procedures, or admissions.
• Educate and involve patients and families in care planning.
• Develop and implement critical pathways.
• Utilize physician advisors and computer systems to track patient status and potential outliers.
• Communicate benefits and financial implications of various health plans to patients and families.
• Manage payor denials and issue hospital-initiated notices of non-coverage (HINNs).
• Identify and document patient/family learning needs and integrate them into care plans.
• Participate in interdisciplinary team (IDT) rounds.
• Conduct utilization reviews and communicate findings with physicians and payors.
• Ensure authorization for hospital stays and report continued stay denials.
• Apply decision support criteria (e.g., InterQual) appropriately.
• Maintain accurate documentation.
• Assist in patient transitions to the next level of care.
• Provide patient and family education for discharge planning.

Qualifications & Requirements:

• Recent (within the last year) acute care Case Management experience preferred.
• Consideration for candidates with 2-3 years of ICU or strong Med-Surg experience if no prior case management experience.
• Case management experience in an LTAC facility is also considered.
• Strong critical thinking skills and understanding of patient medical needs.
• Certification in Case Management, Nursing, or Utilization Review preferred.
• Active RN license in Florida or a compact license (must obtain Florida RN license within 60 days of relocation).
• BLS (AHA) certification required within 30 days of hire.
• Minimum 3 years of RN experience in an acute care setting.
• Graduate of an accredited nursing program; BSN preferred.

Qualities of a Strong Candidate:

• Thrives in a fast-paced and demanding environment.
• Excellent communication and multitasking skills.
• Adaptability and ability to pivot when necessary.
• Not a desk job - candidates should be prepared for an active, hands-on role in patient care coordination.

Interview Process:

Initial Phone Screen: Discussion of role, compensation, and benefits.

Virtual Interview: 30-minute session with the hiring manager.

On-Site Interview & Peer Interview: Includes job shadowing (may require a second visit).

Compensation & Benefits:

• Salary Range: $32.91/hr - $45.25/hr (based on experience)
• Shift Differentials: Evenings - $2.00/hr, Weekends - $2.00/hr
• Sign-On Bonus: $15,000
• Relocation Assistance: Case-by-case basis
• Comprehensive medical, dental, and vision insurance options
• 401(k) with employer match
• Employee stock purchase plan
• Tuition assistance & education benefits
• Paid time off, disability coverage, and family leave
• Wellness programs and employee assistance resources