Care Management Case Manager

West Tennessee Healthcare • White Deer, TX

6d • Onsite

About The Position

Care Management Case Managers provide leadership in the coordination of patient-centered care across the continuum. They develop a safe discharge plan through collaboration with patients/caregivers and the multidisciplinary healthcare team to arrange appropriate post-discharge services and optimal transitions in care. This role facilitates appropriate Length of Stay (LOS), patient satisfaction, and reimbursement for all patients. They develop and maintain collaborative relationships with all members of the healthcare team. Through clinical care coordination, they drive efficient utilization of resources to reduce length of stay, improve patient flow and throughput, limit variation by applying innovative and evidence-based practices, and reduce the risk of readmission.

Requirements

• Current licensure as Registered Nurse in the state of Tennessee.
• Associate or Diploma of Nursing required.
• Minimum 3 years of recent acute clinical care experience preferred.
• Strong communication skills.
• Ability to develop and maintain positive relationships with customers internal and external to WTH.

Nice To Haves

• Bachelor of Science in Nursing preferred.
• AHA Basic Cardiac Life Support preferred.
• ACM, CCM or other certification applicable to Case Management within 3 years of hire preferred.
• Preferred experience in care facilitation and management and utilization review.
• Enterprise Care coordination / discharge and transition planning and community resource knowledge preferred.

Responsibilities

• Obtains or ensures acquisition of appropriate pre-certifications authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party payer guidelines.
• Obtains or facilitates acquisitions of urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements.
• Documents, monitors, intervenes/resolves, and reports clinical denials/appeals and supports retrospective payer audit denials; collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor, and third party payers, etc.
• Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.; serves as an educational resource to all WTH staff regarding utilization review.
• Assumes roles in assessment of physical, psychosocial, & economic needs for transition of care planning to a variety of levels of care; delegates to others as appropriate.
• Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes.
• Interviews and collects patient specified data and chart review related to readmission and appropriately notifies care team.
• Communicates telephonically and electronically with outpatient providers in an effort to enhance the continuum of care.
• Integrates performance improvement principles and customer service excellence principles into all aspects of job responsibilities; practice and governmental commercial payer guidelines.
• Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies.
• Assumes responsibility for WTH required continued education and owns professional growth.
• Performs other duties as assigned or required.

Benefits

• West Tennessee Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered a position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to follow West Tennessee Healthcare’s accommodation precautions to mitigate the spread of illness.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree