Case Management position available in Nashville, TN. Full-time, days between 7A - 7P with weekend rotations. Salary range from $37.77 to $53.32 per hour. Benefits include paid time off, various health insurance options, wellness plans, retirement benefits, long-term and short-term disability, employee assistance programs, parental leave, adoption assistance, tuition reimbursement, and community service opportunities. Compensation varies based on experience, skills, education, performance, location, and salary range at the time of the offer.
Responsibilities include providing health care services regarding admissions, case management, discharge planning, and utilization review. Review admissions and service requests for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria. Provide case management and consultation for complex cases. Assist departmental staff with coding, medical records, precertification, reimbursement, and claim denials/appeals. Assess and coordinate discharge planning needs with healthcare team members. Prepare statistical analysis and utilization review reports as necessary. Oversee and coordinate compliance to federally mandated and third-party payer utilization management rules and regulations.
Requirements include licensure/certification/registration as a Licensed Registered Nurse from the Tennessee Board of Nursing or current home state license for multi-state license recognition "Compact State." Education requirement is a diploma from an accredited school/college of nursing or required professional licensure at time of hire.