Mental Health Case Manager I, RN

Mental Health Case Manager I, RN WakeMed Health & Hospitals - 3.8 Raleigh, NC Job Details Full-time 1 day ago Qualifications Appeals Nursing Utilization review RN License Mental health nursing expertise Insurance claim appeals processing Patient advocacy No experience needed Bachelor's degree Case management Utilization management Task prioritization Substance abuse Conflict management Medical insurance appeals management Discharge planning Bachelor's degree in nursing Client advocacy in social work Patient interaction Referral coordination Documentation review Health education and counseling Entry level Community resource coordination

Nursing Full Job Description Overview:

Supports patients and families in managing mental health and substance use concerns, assisting with discharge planning, resource navigation, and community engagement. Serves as a resource and placement specialist, ensuring timely referrals, warm handoffs, and effective communication. Provide education, advocacy, and support to enhance patient self-management and recovery. Facilitates inpatient and outpatient connections, monitors placements, conducts safety assessments, arranges transportation, and addresses social determinants of health. Acting as a liaison between patients, families, providers, and community resources. Proactively works to prevent delays in care and disposition. Reviews patient admissions and continued stays for appropriateness, monitors insurance benefits, and ensures care aligns with coverage to optimize payment. Assists with insurance appeals and utilization reviews. Supports clinical staff with coverage guidance and medical record reviews. Participates in the involuntary commitment process, including case tracking and representing the hospital in hearings. Must be able to work independently, prioritize tasks, and manage time efficiently. Demonstrates a flexibility in accepting diverse work assignments, managing stress related to change, and resolving conflicts effectively.

Department Description:

Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit www.wakemed.org.

EOE Licensure:

Registered Nurse Required Education:

Bachelor's Degree Nursing Required Experience:

No Experience Required