Category:

RN Professional

City:

Jackson

State:

Tennessee

Shift:

Job Description Summary:

Provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with the patients/caregivers and multidisciplinary healthcare team to arrange appropriate post-discharge services and optimal transitions in care. Facilitates appropriate LOS, patient satisfaction, and reimbursement for all patients. Develops and maintains collaborative relationships with all members of the healthcare team. Through clinical care, coordination drives efficient utilization of resources to reduce the length of stay, improve patient flow and throughput, limits variation by applying innovative and evidence-based practice, and to reduce the risk of readmission.

Responsibilities

Obtains or ensures acquisition of appropriate pre-certifications authorizations from third-party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third-party payer guidelines.
Obtains or facilitates acquisitions of urgent/emergent authorizations, continued to stay authorizations, and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements.
Documents, monitors, intervenes/resolves, and reports clinical denials/appeals and supports retrospective payer audit denials; collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor, and third-party payers, etc.
Assumes roles in assessment physical, psychosocial, & economic needs for the transition of care planning to a variety of levels of care; delegates to others as appropriate.
Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes.
Interviews and collects patient specified data and chart review related to readmission and appropriately notify care team.
Assumes responsibility for WTH required continued education and owns professional growth.

Qualifications

EDUCATION: Bachelor of Science in Nursing preferred. Candidates who are within 6 months of completion of BSN degree will be considered. Bachelor of Science in Nursing requirement waived if employed in Care Management/Documentation Improvement on or prior to 6/1/17.  

LICENSURE, REGISTRATION, CERTIFICATION: Current licensure as Registered Nurse in the state of Tennessee. AHA Basic Cardiac Life Support preferred. ACM, CCM or other certification applicable to Case Management within 3 years of hire preferred  

EXPERIENCE: Minimum 3 years of recent acute clinical care experience preferred Preferred experience in care facilitation and management and utilization review

NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.