Registered Nurse - Case Manager Full Time Days

Williamson Health is a regional healthcare system serving Williamson County, Tennessee, with over 2,300 employees, 30+ sites, and 860 physicians offering a wide range of services. Position Summary Perform activities of Case Management and Utilization Management to facilitate the collaborative management for an entire episode of care for all patients with a multidisciplinary health care team, focusing on resource management and discharge planning. Deliver timely review and delivery of necessary clinical information according to governmental regulations and insurance guidelines for approval of hospital care and correct admission status, optimizing appropriate reimbursement for services while supporting the mission of Williamson Health. Responsibilities Review patients within 24 hours or the next business day after admission and at a minimum every 2 days thereafter for continued stay, applying appropriate criteria and facilitating reimbursement for services with third‑payer parties. Complete assessments and initial status revisions within 24 hours or the next business day, documenting in Meditech/Allscripts. Maintain precise, timely, and appropriate documentation in Allscripts and Meditech, keeping legible hard copy face sheets. Obtain and enter authorization numbers/approval status and notes in Meditech. Facilitate discharge planning, including discussions of discharge choices, appeals, and the Discharge Appeals process. Initiate peer‑to‑peer and initial appeal processes, communicating with physicians and the denials/appeals coordinator within 24 hours or the next business day. Complete all steps of the code 44 process after referral to EHR for those patients not meeting admission criteria, ensuring correct status entry and documentation in Meditech, BAR, and the medical record. Notify physicians, social workers, and patients of NOTA status with delivery of ABN, HINN‑1, or HINN‑10 when appropriate. Collect and enter avoidable days, saved days, and denied days in Allscripts, reporting trends to the Director/Manager. Qualifications & Requirements Licensed Registered Nurse in the State of Tennessee, with Emergency Room or Critical Care experience preferred. Case Management Certification preferred or required within 3 years of employment. Nursing diploma or degree from an accredited college or university. Minimum of 5 years of related experience in a hospital or managed care setting; prior utilization/case management experience is preferred. Demonstrated clinical knowledge base in medical/surgical nursing and/or critical care. Strong organization, time management, problem‑solving, and critical thinking skills. Ability to work independently and in a team under the supervision of a Director/Manager. Effective verbal and written communication skills, efficient review and interpretation of the medical record, and familiarity with Meditech and Allscripts Care Management. General knowledge of governmental and insurance guidelines related to case management compliance, reimbursement, DRG system, and Interqual Criteria. Positive attitude, willingness to learn new processes, and adaptability to change. Required weekend rotation. Physical requirements include office and clinical environment, possible exposure to airborne pathogens, telephone and computer use for extended periods, ability to walk/stand for up to 2 hours per day, clear legible handwriting, and a clear, understandable voice. Benefits Medical, Dental, and Vision insurance PTO (Paid Time Off) Retirement match Tuition reimbursement Discount program FSA (Flexible Spending Account) Identity Theft Protection Legal Aid Physical Requirements Work in office and clinical environments with potential exposure to airborne pathogens. Use of telephone and computer for extended periods. Walk and stand for up to 2 hours per day. Maintain clear, legible handwriting and an understandable voice. Williamson Health is an equal‑opportunity employer and a drug‑free workplace. #J-18808-Ljbffr Williamson Health