RN Case Manager - Utilization Review

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Join our dynamic Case Management team at St. Vincent Healthcare in Billings, MT.  

This RN Case Manager role is focused on Utilization Review of patients out of Surgery or PACU.  In this role you will work closely with providers for next steps for the patient.


The RN Case Manager is responsible for managing a caseload of patients across the continuum of healthcare services and assuring optimal quality outcomes, patient satisfaction, and appropriate use of resources. The Case Manager is responsible for directing an organized, patient-centered interdisciplinary team system that coordinates the delivery of healthcare services by continually monitoring, evaluating, and modifying the treatment plan to achieve optimal patient outcomes and efficacious use of resources.


Essential Duties and Responsibilities

Coordinator and Facilitator of Care

  • Uses and documents levels of care criteria for all patients throughout care continuum and develops and directs continuum of care map in collaboration with interdisciplinary team (IDT)
  • Identifies obstacles to efficiency and goal outcomes and intervenes to overcome or eliminate these when possible


  • Demonstrates caring and involved behaviors to patient/family members and plays an advocacy role to ensure positive outcomes.
  • Identifies possible situations of abuse, neglect or exploitation utilizing knowledge of physical and psychosocial indicators of abuse
  • Negotiates with healthcare agencies for services and identifies internal and/or external resources and refers appropriately to meet patient needs.
  • Identifies patients that may benefit from conversation regarding end-of-life decision making, complete referral to certified facilitator to begin conversation process and attempts to  reduce the frequency of artificially prolonged and painful dying by eliciting preferences, improving understanding of outcomes, encouraging attention to pain control, advance care planning, and patient-physician communication

Discharge Planner

  • Continuously assesses, develops, and implement discharge patient/family needs and works with appropriate healthcare provider to procure necessary services.
  • Effectively communicates and involves patient/family in discharge planning and coordinates finalization of all discharge related recommendations.



  • Current MT RN license
  • Previous experience as a Case Manager, or minimum 3 years current clinical hospital experience, or Nursing Management experience, or current clinical experience working within the Care Management department.
  • Current Case Manager Certification preferred
  • Current BLS certification
  • Ability to communicate effectively and diplomatically within a multi-functional team
  • Strong organizational skills and attention to detail
  • Ability to successfully function in a fast paced, service oriented environment
  • Experience in understanding and usage of computers as well as the ability to learn applications relevant to the position
Organization: St. Vincent Healthcare, Billings, MT
Primary Location: MT-Billings/Surrounding Areas-Billings
Department: SVB-Utilization Review
Schedule: Full-time
Shift: Day Shift
Job Posting: 8/8/2017 11:02:58 PM
FTE: 1.0
Job Number: 17006097
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