Case Manager

5 days ago

Nashville, United States United Surgical Partners International Inc (USPI) Full time

Full-time: Case Manager

 

Join Saint Thomas Hospital for Specialty Surgery's outstanding clinical team

  • Shift Differential
  • Competitive pay rates
  • Full-Time Days
  • Rotating On Call Weekends

 

As a leader in spinal and joint replacement surgery, we are proud of what we’ve achieved, and we believe that it’s our employees who have made that success possible. We strive to take good care of our employees, and we are always looking for exceptional talent. If you’re looking for an opportunity to be part of an extraordinary team, please consider Saint Thomas Hospital for Specialty Surgery. We would love for you to join us

 

  • Culture: Family oriented, collaborative efforts, open door policy
  • Quality Care: One of the only hospitals in Nashville with a Five-Star Rating from the Centers for Medicare & Medicaid Services, Top 5% in the U.S. for spinal surgery, numerous Healthgrades awards for spinal and joint replacement surgery
  • Benefits: Health, dental, vision, disability, life insurance, PTO, 401K with company match, competitive compensation, Employee Assistance Program reimbursement for certification/licensure renewals
  • Education: Tuition reimbursement, training/in-services
  • Recognizing and listening to our employees: Good Catch awards, employee appreciation week, Employee Leadership Committee, Employee bonuses

 

Job Summary

The individual in this position is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination.  The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.  This position integrates national standards for case management scope of services including:

  • Utilization Management supporting medical necessity and denial prevention
  • Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
  • Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at appropriate level of care 
  • Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
  • Education provided to physicians, patients, families and caregivers
  • Precepts new staff members and acts as resource to all staff. 
  • Participates in department Quality improvement initiatives, one committee participation and/or major Projects as assigned

 

Job Responsibilities 

  • Accurate medical necessity screening and submission for UR committee review
  • Care coordination
  • Transition planning assessment and reassessment
  • Implementation or oversight of implementation of the transition plan
  • Leading and facilitating multi-disciplinary patient care conferences
  • Managing concurrent disputes
  • Making appropriate referrals to other departments
  • Communicating with patients and families about the plan of care
  • Collaborating with physicians, office staff and ancillary departments
  • Assuring patient education is completed to support post-acute needs
  • Timely complete and concise documentation in the Case Management documentation system
  • Maintenance of accurate patient demographic and insurance information
  • Identification and documentation of  potentially avoidable days
  • Identification and reporting over and underutilization
  • Other duties as assigned.

 

Benefits

  • Health, Dental, Vision, disability, and life insurance
  • Health Savings Account
  • Flexible Spending Account
  • Retirement plan with company match
  • Tuition reimbursement
  • 7 paid holidays
  • Reimbursement for license renewals
  • Paid Time Off
  • Competitive compensation
  • Employee Assistance Program

#LI-SB1
#USP-123



Required Skills
  • Active Registered Nurse license with at least two years acute hospital patient care experience.
  • BSN preferred Accredited Case Manager (ACM) or CCMpreferred.
  • Acute hospital case management experience preferred.
  • Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy.


Required Experience
  • Active Registered Nurse license with at least two years acute hospital patient care experience.
  • BSN preferred Accredited Case Manager (ACM) or CCMpreferred.
  • Acute hospital case management experience preferred.
  • Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy.

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