Top 68 Utilization management nurse Jobs in Oak Ridge Tn

Registered Nurse RN - Hospital Care Manager
Prisma Health —Maryville, TN
- Full-time
- Acute care
- Nursing
- RN License
6d
Onsite Care Coordination Nurse
Humana —Rockford, TN
- $71,100 - $97,800 a year
- Full-time
- Hybrid work
- Acute care
- Spanish
- Nursing
- Paid parental leave
- Paid holidays
4d
Registered Nurse (RN) - Hospital Care Manager, Hospital Care Management, PRN, Days
Prisma Health —Maryville, TN
- PRN
- Acute care
- Nursing
- RN License
6d
Registered Nurse - Neuroscience Med/surg
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
Registered Nurse Emergency Department
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
Registered Nurse RN Orthopedic Surgery
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
- Health insurance
Registered Nurse Emergency Department
Prisma Health —Maryville, TN
- Part-time
- Acute care
- Nursing
- Medication administration
Registered Nurse RN Neuroscience Med/surg
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
Registered Nurse Resident RN-Acute Care Medical/surgical
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
Registered Nurse RN ICU
Prisma Health —Maryville, TN
- Weekends as needed
- Nursing
- Medication administration
- RN License
Registered Nurse
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
Registered Nurse Blount Orthopedic Surgery
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
- Health insurance
Registered Nurse Emergency Department
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
Registered Nurse Medical/surgical Nursing
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
Registered Nurse- Acute Care
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
Registered Nurse Orthopedic Med/surg
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
- Health insurance
Registered Nurse RN Medical Telemetry
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
Registered Nurse - Neuroscience Med/surg
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration
Registered Nurse- Acute Care Blount Medical/surgical Nursing
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
Registered Nurse Emergency Department
Prisma Health —Maryville, TN
- Weekends as needed
- Acute care
- Nursing
- Medication administration

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Registered Nurse RN - Hospital Care Manager

Prisma Health -
Maryville, TN

Apply Now

Job Details

Full-time
6 days ago

Qualifications

RN License
Acute care facility experience

Full Job Description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Integral care team partner that focuses on patient engagement and activation, has primary accountability for patients' care transition out of the acute care setting and positively impacts longitudinal care plan alignment. In collaboration with physicians, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care. Leads the team for each patient individually with the goal to maximize autonomy where possible.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.
Partners with the attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost effective care. Anticipate next steps and facilitate communication to maximize care efficiencies for the patient and family.
Identifies social determinants of health that increase the patient's risk for negative outcomes. Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate. Facilitates patient access to resources and relevant services.
Addresses and resolves system problems impeding diagnostic or treatment progress. Proactively identifies, resolves and documents delays and obstacles on the patient's behalf. Drives change by identifying areas where performance improvement is needed.
Navigates value-based care with expertise and ensures longitudinal plan is patient focused and aligns with patient and caregiver goals.
On the basis of preliminary risk screening, assesses patients' and family's psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
Maintains expert level knowledge of body systems and expected clinical outcomes for patient disease process. Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in an acute care setting. Maintains care management knowledge to provide services in accordance with standards of practice as established by department and management.
Ensures medical necessity, appropriate level of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan.
Navigates the team through complex compliance, regulatory and insurance requirements. Coordinates with third party payors on a regular basis.
Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary. Includes, but not limited to, delivery of the regulatory documents as provided by CMS.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
Performs other duties as assigned.

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Qualifications

Education - Bachelor's degree in Nursing
Experience - Three (3) years acute care nursing experience. One (1) year acute care case management experience preferred.

In Lieu Of

In lieu of the BSN requirement above, a nursing diploma or an Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding (MOU) agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within (4) four years of hire date. Further, employees must demonstrate sufficient progress annually toward obtaining an accredited BSN or MSN degree to remain eligible for employment or may be terminated.
Employees in this title prior to 10/24/2021 are grandfathered into the title and are only required to have an AD N or Nursing Diploma.

Required Certifications, Registrations, Licenses

Licensed to practice as a Registered Nurse in South Carolina
Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred.

Knowledge, Skills and Abilities

Knowledge of Medical Necessity Criteria is preferred.

Work Shift

Day (United States of America)

Location

Blount Memorial Hospital

Facility

8001 Blount Memorial Hospital, Inc.

Department

80017517 BMH Hospital Care Management

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Apply Now

Refine Your Search

utilization management nurse jobs in oak ridge tn

Registered Nurse RN - Hospital Care Manager

Onsite Care Coordination Nurse

Registered Nurse (RN) - Hospital Care Manager, Hospital Care Management, PRN, Days

Registered Nurse - Neuroscience Med/surg

Registered Nurse Emergency Department

Registered Nurse RN Orthopedic Surgery

Registered Nurse Emergency Department

Registered Nurse RN Neuroscience Med/surg

Registered Nurse Resident RN-Acute Care Medical/surgical

Registered Nurse RN ICU

Registered Nurse

Registered Nurse Blount Orthopedic Surgery

Registered Nurse Emergency Department

Registered Nurse Medical/surgical Nursing

Registered Nurse- Acute Care

Registered Nurse Orthopedic Med/surg

Registered Nurse RN Medical Telemetry

Registered Nurse - Neuroscience Med/surg

Registered Nurse- Acute Care Blount Medical/surgical Nursing

Registered Nurse Emergency Department

I want to receive the latest job alert for utilization management nurse in oak ridge tn

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