Overview Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities Utilization Review
Discharge planning
Readmission Reduction Participation
Payer Communication and denial reduction
Completes assigned goals.
Qualifications Experience
Minimum Required: RN with at least one (1) year of clinical experience
Preferred/Desired: RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required: Diploma or Associate Degree in Nursing
Preferred/Desired: BSN or MSN
Training
Minimum Required: Certified Case Manager
Special Skills
Minimum Required: Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired: Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
Minimum Required: RN
Preferred/Desired: RN;CCM;ACM
Seniorities and Employment Seniority level: Entry level
Employment type: Other
Job function: Health Care Provider
Industries: Hospitals and Health Care
Location: Collierville, TN