Care Manager RN

7 days ago


Pulaski, Tennessee, United States Southern Tennessee Regional Health System - Pulaski Full time
Job Title: Care Manager RN

Earn a competitive salary of $85,000 - $110,000 per year as a Care Manager RN at Southern Tennessee Regional Health System - Pulaski.

About the Role:

The Care Manager RN will be responsible for analyzing patient records to determine legitimacy of admission, treatment, and length of stay in our health care facility. This involves performing duties through personally or through subordinate supervisors to comply with government and insurance company reimbursement policies.

Key Responsibilities:

  • 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.
  • 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.
  • Facilitate 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.
  • 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.

Requirements:

  • Current RN license in the State of Tennessee
  • High level interpersonal skills to handle sensitive and confidential information.
  • Certifications: Basic Life Support (BLS) within 90 days of hire date.
  • Minimum of 5 years as a clinical nurse.

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