To perform the activities of Case Management and Utilization Management to facilitate the collaborative approach of the multi-disciplinary team for patients during their episode of care. Reviews and delivers necessary clinical information timely to third party payers with compliance to governmental regulations and insurance guidelines. Reviews for Hospital appropriateness in the correct admission status. Facilitates discharge planning activities with healthcare team while optimizing appropriate length of stay.
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Must be currently licensed by the State of Tennessee as a Registered Nurse.
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Case Management Certification preferred/required within 3 years of employment
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5 years Medical Surgical Experience/Case Management/Acute Hospital preferred
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Demonstrated clinical knowledge base in medical/surgical nursing.
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Demonstrated organization, time management, problem solving and critical thinking skills.
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Able to perform independently and in team situations under the supervision of a Director/Manager.
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Demonstrated effective verbal and written communication skills.
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Efficient review and interpretation of the medical record.
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Familiar with Meditech, Care Management, basic computer skills required.
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General knowledge of Governmental and Insurance guidelines related to case management compliance, reimbursement, DRG system and Interqual/MCG Criteria preferred.
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Positive attitude with a willingness to learn new processes and adjusts well to change.
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Required Weekend Rotation
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Office and Clinical environment.
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Possible exposure to airborne pathogens.
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Telephone and computer use for extended periods of time.
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Able to walk/stand, up to 2 hours/day.
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Clear legible handwriting
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Clear understandable voice.
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Consistently sets priorities and exhibits efficient time management skills with assigned workload within the confinements of scheduled shift.
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Timely reviews hospital admissions within the guidelines of the UR Plan consistently using appropriate criteria.
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Monitors and Reviews assigned Observation patients at least once daily maintaining an observation rate of = /< 18% (<15%=above expectation).
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Initiates discharge needs assessment on all INPTS within 24 hours of admission, with completion within 24 hours of discharge.
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Consistently facilitates conversations comparing EDD and GMLOS of assigned patients during MDR and encourages proactive discharge planning. (Excluding moms/babies/NICU/PEDS)
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Maintains an average hospital monthly LOS <3.5 days. (=/ < 3 days = Above Expectation)
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Consistently completes pending insurance list by the end of each Friday.
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Timely identification of the Initial and follow-up Important Message Notification for a departmental average of 97% of all Medicare and Medicare Advantage Beneficiaries.
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Consistently Reviews Surgery schedule emails and SDC patients daily for correct procedure/status/authorization, and communicates any changes or discrepancies to appropriate parties preventing reimbursement denials.
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Completes discharge appeals process for Inpatients and ABN delivery for inappropriate outpatient stays as defined by policy.
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Performs within the CAHPS standards regarding "nurses explain in way you understand".
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Performs within the CAHPS standards regarding communication with nurses, as shown on CAHPS standards.
Req Benefits:
Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being.
- Medical, Dental, Vision
- PTO
- Retirement Matching
- Tuition reimbursement
- Discount programs
- FSA (Flexible Spending Accounts)
- Identity Theft Protection
- Legal Aid
Williamson Health is an equal-opportunity employer and a drug-free workplace.
Additional Details :
Williamson Health is a regional healthcare system based in Williamson County, Tennessee, with more than 2,500 employees across more than 30 locations and more than 860 physicians and advanced care practitioners offering exceptional healthcare across 60-plus specialties and subspecialties close to home. The flagship facility, Williamson Medical Center, a 337-bed facility which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Other Williamson Health service providers include the Bone and Joint Institute of Tennessee, The Turner-Dugas Breast Health Center, Monroe Carell Jr. Children's Hospital Vanderbilt at Williamson Medical Center, Williamson Health physician practices that are strategically located throughout the community, countywide Emergency Medical Services that include 18 rapid response units, Williamson Health Foundation, and multiple joint venture Vanderbilt Health and Williamson Medical Center Walk-In Clinics in Williamson County. Learn more about our many specialized services at WilliamsonHealth.org.
Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We're committed to empowering our employees to work in innovative ways and reserve time and space for curiosity, laughter and creativity. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.
Company Culture:
We are passionate about the care we offer and also our standards of performance which include compassion, respect, accountability and safety - toward our patients and also toward our colleagues. We're looking for talented, caring, and mission-minded professionals who view their career in healthcare as more than just a paycheck, but as a true calling. We are proud of our unique culture that balances doing what we love, working alongside a supportive team, and maintaining a good quality of life - all while making a difference no matter your department or position.
Community Overview:
Franklin sits in the heart of Williamson County, which has the top-rated school system in the state, a plethora of parks and green spaces, fabulous restaurants, a rich traditional of hospitality, and of course, world-class healthcare. Various publications have showered Franklin with such accolades as one of the "Best Southern Towns," "Best Place to Live," "Top 10 Community for Job Growth," and "Top 50 Cities to Start a Small Business."
