RN Ambulatory Case Management Full Time

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• The RN – Ambulatory Case Management is responsible for the clinical coordination of care across ambulatory settings
• This role ensures effective utilization of services, supports transitions of care, and promotes health outcomes by addressing medical, psychosocial, and social determinants of health
• The RN collaborates with multidisciplinary teams to optimize quality, patient satisfaction, and resource efficiency while supporting compliance and population health goals

Essential Functions

• Evaluates patients’ care plans, admission needs, and transitions across ambulatory and inpatient settings
• Supports discharge planning and post-acute referrals to outpatient clinics and community services
• Conducts chart reviews to monitor care quality, compliance, and cost effectiveness
• Collaborates with providers, specialists, and community agencies to align care delivery and reduce avoidable admissions
• Supports certification and authorization processes with private insurers and other payors
• Screens patients for high-risk indicators and coordinates proactive interventions
• Educates and advocates for patients and families navigating complex care plans
• Documents interactions, assessments, and plans accurately and timely
• Participates in ambulatory quality initiatives, population health strategies, and chronic care management
• Responds to patient and family inquiries, complaints, and concerns in a timely, professional manner

Knowledge/Skills/Abilities/Expectations

• Strong critical thinking and care coordination skills
• Working knowledge of insurance authorization, case review, and utilization management
• Excellent communication and documentation skills
• Ability to manage multiple complex cases independently
• Proficiency in EMR systems and data reporting
• Familiarity with quality improvement principles and population health strategies
• Conduct assessments and develop individualized care plans
• Connect patients with resources (housing, transportation, food, financial aid, medication access)
• Monitor medication adherence and support pharmacy coordination
• Provide education and host community workshops or training sessions
• Respond to crises, coordinate care in emergencies, and offer emotional support
• Advocate for patients’ rights and support system navigation
• Maintain up-to-date knowledge of regulatory and quality metrics impacting care delivery

Education

• Graduate of an accredited school of nursing
• BSN preferred

Licenses/Certifications

• Current RN license in the state of practice or Compact State License
• BLS certification required upon hire and maintained thereafter
• ACLS certification required within six (6) months of hire

Experience

• Minimum five (5) years of progressive clinical nursing experience
• Minimum two (2) years of supervisory or case management experience
• Experience in ambulatory care or population health preferred