Top 6 Utilization review nurse Jobs in Morristown, Tn

Care Manager RN PRN
Newport Medical Center —Newport, TN
- Part-time
- Nursing
- RN License
- BLS Certification
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Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Care Manager RN PRN

Newport Medical Center -
Newport, TN

Quick Apply

Job Details

Part-time

Qualifications

RN License
Associate's degree
Associate Degree in Nursing

Full Job Description

Job Summary

The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards.

Essential Functions

Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services.
Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues.
Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs.
Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions.
Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
Provides assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.

Qualifications

Associate Degree in Nursing required
Bachelor's Degree in Nursing preferred
2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required
2-4 years of care management experience preferred

Knowledge, Skills and Abilities

Strong understanding of case management principles, discharge planning, and transitions of care.
Knowledge of federal, state, and Joint Commission standards related to case management.
Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams.
Ability to assess complex situations, identify solutions, and implement care plans efficiently.
Proficiency in electronic medical records (EMR) and documentation systems.
Strong organizational and time management skills to prioritize tasks in a dynamic environment.

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure state licensure in state of employment or Compact state licensure required
Accredited Case Manager (ACM) preferred
CCM - Certified Case Manager preferred
BLS - Basic Life Support preferred

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utilization review nurse jobs in morristown, tn

Care Manager RN PRN

Utilization Management Reviewer

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