Registered Nurse; RN) Case Manager

Frye Regional Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Registered Nurse (RN) joining our team, you are embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

The Case Manager (CM) is responsible for providing care coordination including needs assessment and identification of care options, communication with patients and families in an interdisciplinary environment consistent with the position's qualifications, professional practices and ethical standards.

• Supportive Leadership
• Team-Oriented Culture
• Diverse Patient Population

A Registered Nurse (RN) who excels in this role:

• Coordinates management of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.
• Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs.
• Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management and discharge planning.
• Provides ongoing support and expertise through comprehensive assessment, care coordination, plan implementation and overall evaluation of individual patient needs while ensuring patient preferences.
• Serves as a patient advocate through resource utilization, discharge planning and addressing the holistic needs of the patient.
• Completes departmental orientation, initial and annual competencies.
• As appropriate, consults other departmental staff to collaborate in patient care delivery, identify barriers to care and or discharge and develop solutions/resolution.
• Completes documentation per workflow timeline and content requirements including completion of the Individual Plan of Care (IPoC) per CMS guidelines.
• Schedules family conferences and/or communicates with caregiver following each team conference and more often as needed to keep patient and designated caregiver informed of progress and provides appropriate information related to goal achievement, course of rehabilitation stay, and plans for discharge.
• Reviews the patient's assigned CMG and helps the team identify any potential missed comorbid conditions that are actively being treated during the patient's stay. Communicates any findings to the HIM team.
• Assists with concurrent and retrospective utilization review activities including denials and appeals. Works with physicians to conduct peer review with payer medical director when indicated.
• Ensures clinical updates are provided to all insurance payers when due and all payer communications are documented in Meditech.
• Identifies trends that impact the quality, cost effectiveness, patient experience and delivery of care services and brings to departmental leadership meetings for discussion and action.
• Performs intake assessment on patient within 24 to 72 hours of admission, preferably within 48 hours.
• Performs follow-up assessments per Case Management Plan and/or hospital policy.
• Demonstrates an ability to be flexible, organized and function under stressful situations.

Applicants should have a current state RN license. Bachelor's degree preferred but not…