Registered Nurse (RN) - Emergency Department Weekend Only Shift

ABOUT WILLIAMSON HEALTH | Williamson Health is a regional healthcare system based in Williamson County, Tennessee, with more than 2,300 employees across more than 30 locations and more than 860 physicians and advanced care practitioners offering exceptional healthcare across 60-plus specialties and subspecialties close to home. The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Other Williamson Health service providers include the Bone and Joint Institute of Tennessee, The Turner-Dugas Breast Health Center, Monroe Carell Jr. Children's Hospital Vanderbilt at Williamson Medical Center, Williamson Health physician practices that are strategically located throughout the community, countywide Emergency Medical Services that include 18 rapid response units, Williamson Health Foundation, and multiple joint venture Vanderbilt Health and Williamson Medical Center Walk-In Clinics in Williamson County. Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.

Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being.

o Medical, Dental, Vision

o Retirement Matching

o Tuition reimbursement

o FSA (Flexible Spending Accounts)

o Legal Aid

Williamson Health is an equal-opportunity employer and a drug-free workplace.

To perform the activities of Case Management and Utilization Management to facilitate the collaborative management for an entire episode of care for all patients with the multidisciplinary health care team, focusing on resource management and discharge planning. Performs 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.

Formal Education / Training:

Must be currently licensed by the State of Tennessee as a Registered Nurse.

Emergency Room and or Critical Care preferred

Case Management Certification preferred/required within 3 years of employment

Earned a nursing diploma or degree from a college or university

Recent minimum 5 years related experience in hospital or managed care setting.

Prior utilization/case management experience is preferred.

Equipment and Skills Training:

Demonstrated clinical knowledge base in medical/surgical nursing and or critical care.

Able to perform independently and in team situations under the supervision of a Director/Manager.

Efficient review and interpretation of the medical record.

Familiar with Meditech, Allscripts Care Management, Fax, Copier, basic computer skills preferred.

General knowledge of Governmental and Insurance guidelines related to case management compliance, reimbursement, DRG system and Interqual Criteria preferred.

Required Weekend Rotation

Office and Clinical environment.

Telephone and computer use for extended periods of time.

PERFORMANCE STANDARDS

Consistently sets priorities and exhibits efficient time management skills with assigned workload within the confinements of scheduled shift.

Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.

Completes assessments and initial status revision within 24 hours or next business day, documenting in Meditech/Allscripts.

Maintains knowledge of assigned patient's clinical condition, plan of care, discharge plan and payer source information as demonstrated in group and individual discussions

Timely delivery of the Initial and Follow-up Important Message Notification according to departmental policy for 75% of assigned and appropriate patients.

Initiates peer to peer and initial appeal process as shown by consistent, clear communication to the physician and denials/appeals coordinator within 24 hours or next business day of notification of denial and documentation in Meditech/Allscripts &/or BAR.

Complete documentation which includes hard copy forms, ensuring the status order is entered and correct in the Medical Record followed by documentation in Meditech, BAR and condition code is entered.

Timely notification to Physician, social worker, and patient of NOTA status with delivery of ABN, HINN-1 or HINN-10 when appropriate