Overview Be among the first 25 applicants. WhidbeyHealth is seeking an RN Care Manager in Coupeville, WA. The role supports utilization review and discharge planning from admission through discharge in a fast-paced, collaborative environment.
Location: Coupeville, WA. Department: Nursing. Employment type: Full-time, Days (10 hour shifts), 7 days a week as needed. Work Location: Onsite. FTE: 1. Posted 09/29/2025. Req # 16300.
Responsibilities Lead assessment of patient clinical needs and construct care plans including DME, home health, hospice, skilled nursing, antibiotic regimens, and other resources.
Follow the hospital\'s Case Management / Utilization Plan to integrate utilization review, discharge planning, and resource management to ensure care is provided in the most appropriate setting with the goal of improved quality, optimized outcomes, and cost efficiency.
Evaluate patient care delivery within the hospital and perform denial management during admission or post-discharge; act as a resource to the interdisciplinary team for utilization review, status determination, clinical resource utilization, discharge planning, and appeals.
Communicate with patients, families, and the interdisciplinary health care team using the nursing process (assess, plan, implement, monitor, evaluate) for post-hospital discharge needs.
Coordinate care through electronic communication (e.g., check WhidbeyHealth email at least 3 times daily and use TEAMS messaging).
Participate in multidisciplinary treatment planning and rounds; document changes accordingly.
Contact discharged patients within 24 hours of discharge for follow-up when appropriate.
Ensure timely admission medical necessity reviews and ongoing reviews per payer requirements; collaborate with payers, Patient Access, PFS, and HIM as needed.
Escalate medical necessity concerns to the Physician Advisor or leadership; assist with discharge appeals as appropriate.
Identify and communicate about avoidable days; support leadership with performance improvement initiatives.
Maintain documentation compliance, ensure handoffs, and uphold hospital policies, regulations, and confidentiality.
Assist with regulatory forms, insurance communications, and ongoing authorization processes; participate in performance improvement activities and utilization review committees.
Contribute to the organization\'s values and continuous improvement initiatives; ensure a safe environment for staff, patients, and visitors.
Qualifications Education Graduate of an accredited school of nursing.
BSN preferred.
Training & Experience Minimum of 3 years of current RN experience.
Minimum of two years in utilization review, case management, or discharge planning in a hospital inpatient acute care unit, health plan, or both.
Experience using MCG or InterQual criteria to determine appropriate level of care preferred.
Experience documenting clinical summaries to support medical necessity decisions; ability to draft concise, fact-based clinical summaries.
Ability to document and communicate clearly to support appropriate payment resolution.
Certificates, Licenses & Registrations Washington State DOH RN License required.
Current BLS HCP required.
CCM or ACM preferred.
Benefits, Wage & Additional Details Benefit Information and Wage Transparency: WhidbeyHealth employees who work a 0.5 FTE or higher are benefit eligible. Wage Range: $40.00 - $72.00 per hour.
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