At CoreCivic, our employees are driven by a deep sense of service, high standards of professionalism and a responsibility to better the public good. CoreCivic is currently seeking a Utilization Management/ Case Management Nurse located at our corporate office in Brentwood, TN.  Come join a team that is dedicated to making an impact for the people and communities we serve.

This position would require a hybrid work schedule of 3 days per week onsite and 2 days remote out of our Brentwood, TN office location.  

The Utilization Management/Case Management Nurse provides Utilization Review and Case Management functions for the organization under the direction of the Director, Case Management and within the established policies and procedures. Performs preadmission, concurrent and retrospective review for all patients, completes assessments for the purpose of identifying discharge-planning needs, and provides discharge-planning services for select patient populations. Collaborates with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge.

 

ESSENTIAL FUNCTIONS:

The incumbent should be able to perform all of the following functions at a pace and level of performance consistent with the job performance requirements.

Monitors patient care by performing continuous assessments and evaluations to ensure patient is progressing towards desired outcomes.  Identifies and resolves barriers that hinder effective patient care. Applies knowledge of the patient population served; proves age-specific care; applies knowledge of expected norms in planning care.  Creates plan for care across the continuum.  Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity.Maintains ongoing dialogue with supervisor and other healthcare providers to ensure effective implementation of care plans. Counsels with patients and family members in decision making and in meeting the needs of the patient.  Maintains knowledge of resources and facilities available to patients and family members.Coordinates the discharge planning process ensuring involvement of all members of the healthcare team.  Collaborates and consults with physicians on patient’s progress and discharge planning needs.Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions of care.Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement. Domestic U.S. travel may be required.

Qualifications:

Graduate from an accredited college or university with a degree in nursing or in a healthcare/business related field is required. 
Must possess current LPN licensure in the state of Tennessee.  Advanced degree in nursing or related healthcare field is preferred.  Three years of hospital, health care system, or health plan nursing experience required. Knowledge of CMS guidelines and experience working with payer specific guidelines and contractual rules. Case Management certification credentialed by ACMA or CCMC or BLS provider certification preferred.  Proficiency in Microsoft Office applications required. A valid driver’s license is required.

CoreCivic is a Drug-Free Workplace and EOE – including Disability/Veteran