Case Manager RN
Company: Southern Tennessee Regional Health System - Pulask
Location: Pulaski
Posted on: September 27, 2024
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Job Description:
Job DescriptionAnalyzes patient records to determine legitimacy
of admission, treatment, and length of stay in health care facility
to comply with government and insurance company reimbursement
policies by performing the duties required through personally or
through subordinate supervisors. Reports to: CNOEssential Functions
Evaluate each Inpatient and Outpatient case within 24 hours of
admin to assure appropriate physician order and other documentation
to support the appropriate level of care for the patient based upon
criteria set for my CMS and by Commercial Insurance
Companies.Assure appropriate insurance authorizations as
needed.Work with Medical Staff to educate and facilitate required
documentation to support the appropriate level of care for each
patient, including participation in the Clinical Documentation
ProgramFacilitate Discharge Planning through team collaboration for
each patient that includes services required post discharge such as
Home Health, Outpatient Therapies or skilled nursing care including
Swing Beds and education regarding that care.Documents actions
taken to evaluate and facilitate the Case Mgt review and discharge
planning.Participate in statistical tracking and reporting of the
Utilization Management metrics.Facilitates appeals of denials as
needed, including analysis and corrective actions for denials due
to those processes within the scope of the Case Management
functions.Organizational Expectations Actively participates in
Foundation Safety Behavior Tools and Tactics such as Briefs,
Debriefs, Huddles, Learning Board Activities, Executive Patient
Safety Rounds and reporting of unanticipated and unintended patient
events regardless of whether there is a harm.Provide effective
mentoringBe loyal to the absentAlways manage upConsistent use of
AIDET & 5 P'sUphold the facilities Standards of PerformanceJob
Requirements Minimum EducationCurrent RN license in the State of
TennesseeRequired SkillsHigh level interpersonal skills to handle
sensitive and confidential information. Position required ability
to work with patients and families to achieve appropriate continuum
care for the patient.Required SkillsCertifications:Basic Life
Support (BLS) within 90 days of hire date.Advanced Cardiovascular
Life Support (ACLS) within 90 days of hire date.Pediatric Advanced
Life Support (PALS) within 90 days of hire date.Neonatal
Resuscitation Provider (NRP) within 90 days of hire
date.Perioperative Nurse (CNOR) within 90 days of hire
date.Required SkillsLicenses: Current Tennessee RN license.Required
SkillsBasic computer skills.Equal opportunity and affirmative
action employers and are looking for diversity in candidates for
employment: Minority/Female/Disabled/Protected Veteran
Keywords: Southern Tennessee Regional Health System - Pulask, Huntsville , Case Manager RN, Healthcare , Pulaski, Alabama
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