Registered Nurse (RN)-Hospital Case Manager, Pediatrics, PRN, Days
Company: Prisma Health
Location: Greenville
Posted on: November 1, 2025
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Job Description:
Inspire health. Serve with compassion. Be the difference. Job
Summary The Hospital Case Manager (HCM) provides case management
service for hospital patients, including, but not limited to,
utilization management to ensure efficient, cost-effective patient
progression through the continuum of care and discharge to an
appropriate level of care. In collaboration with physicians, leads
the multidisciplinary team including clinical staff and payors to
ensure efficient delivery of quality, cost-effective care.
Essential Functions All team members are expected to be
knowledgeable and compliant with Prisma Health's values: Inspire
health. Serve with compassion. Be the difference. Partners with the
attending providers throughout hospitalization to promote effective
and efficient utilization of clinical resources, ensuring quality,
cost effective care. Anticipate next steps and facilitate
communication to maximize care efficiencies for the patient and
family. Identifies social determinants of health that increase the
patient's risk for negative outcomes. Ensures clear documentation
for the interdisciplinary care team and coordinates post-acute
plans with the ambulatory care management team as appropriate.
Facilitates patient access to resources and relevant services.
Addresses and resolves system problems impeding diagnostic or
treatment progress. Proactively identifies, resolves and documents
delays and obstacles on the patient's behalf. Drives change by
identifying areas where performance improvement is needed.
Navigates value-based care with expertise and ensures longitudinal
plan is patient focused and aligns with patient and caregiver
goals. On the basis of preliminary risk screening, assesses
patients' and family's psychosocial risk factors through evaluation
of prior functioning levels, appropriateness and adequacy of
support systems, reaction to illness and ability to cope. Maintains
expert level knowledge of body systems and expected clinical
outcomes for patient disease process. Maintains current knowledge
of changes in state and federal regulatory requirements related to
the provision of care management services in an acute care setting.
Maintains care management knowledge to provide services in
accordance with standards of practice as established by department
and management. Ensures medical necessity, appropriate level of
care and timely implementation of plan of care in accordance with
hospital(s) Utilization Review Plan. Navigates the team through
complex compliance, regulatory and insurance requirements.
Coordinates with third party payors on a regular basis. Serves as a
resource for patients and families with regard to their rights and
responsibilities, when payment of care is denied or when care is no
longer medically necessary. Includes, but not limited to, delivery
of the regulatory documents as provided by CMS. Advocates for
patient and family empowerment and independence to make autonomous
health care decisions and access needed services within the health
care system. Performs other duties as assigned.
Supervisory/Management Responsibilities This is a non-management
job that will report to a supervisor, manager, director or
executive. ? Minimum Qualifications Education - Bachelor's degree
in Nursing Experience - Three (3) years acute care nursing
experience. One (1) year acute care case management experience
preferred. In Lieu Of In lieu of the BSN requirement above, a
nursing diploma or an Associate degree in Nursing may be considered
if the applicant signs a BSN Memorandum of Understanding (MOU)
agreeing to enroll in an accredited BSN or MSN program within one
year and obtain a BSN or MSN degree within (4) four years of hire
date. Further, employees must demonstrate sufficient progress
annually toward obtaining an accredited BSN or MSN degree to remain
eligible for employment or may be terminated. Employees in this
title prior to 10/24/2021 are grandfathered into the title and are
only required to have an AD N or Nursing Diploma. Required
Certifications, Registrations, Licenses Licensed to practice as a
Registered Nurse in South Carolina Accredited Case Manager (ACM) or
Certified Case Manager (CCM) is preferred. Knowledge, Skills and
Abilities Knowledge of Medical Necessity Criteria is preferred.
Work Shift Day (United States of America) Location Greenville
Memorial Med Campus Facility 1008 Greenville Memorial Hospital
Department 10087517 GMH Hospital Care Mgmt Share your talent with
us! Our vision is simple: to transform healthcare for the benefits
of the communities we serve. The transformation of healthcare
requires talented individuals in every role here at Prisma
Health.
Keywords: Prisma Health, Greenville , Registered Nurse (RN)-Hospital Case Manager, Pediatrics, PRN, Days, Healthcare , Greenville, South Carolina
