RN Case Manager | Full Time | Chatuge Regional Hospital

Case Management and Social Services

The primary purpose of this job is to do case management as well as social services activities - and utilization review duties.

Duties & Responsibilities may include - but not limited to:

• Complete chart reviews to:
• Assess medical necessity for the level of care and services provided using criteria as directed by the patient's payor sources
• Document in the UR note and complete certifications or forward information to payor's as required by payor source.
• Assist quality department in compliance with core measures.
• Improve concurrent documentation to optimize quality of patient care and accurate reimbursement.
• Participate in denial management and complete the appeals process.
• Assess discharge needs of patients, document in medical record, meet discharge needs, and participate in multidisciplinary team meetings.
• Utilize strategies to decrease re-admissions (complete risk assessments on inpatients, obtain referrals as needed, coordinate care with patient, family and doctor.

Education & Licensure:

Associates degree/Bachelor degree in Nursing - Licensed Registered Nurse (RN) - REQUIRED.

ACLS and BLS certifications. Two years Case Management experience - preferred.

Med/Surg background, Knowledge of Cerner and MCG (Indicia), and Case Management experience - preferred