Registered Nurse - Case Manager

Position Summary

Perform Case Management and Utilization Management duties to facilitate collaborative care for patients across the entire episode of care. Responsibilities include timely review and delivery of clinical information required for approval of hospital care, accurate admission status, and reimbursement optimization while supporting Williamson Health’s mission.

• Must be licensed in Tennessee as a Registered Nurse.
• Case Management Certification preferred or required within 3 years of employment.
• Emergency Room or Critical Care experience preferred.
• Minimum 5 years of hospital or managed‑care related experience.
• Prior utilization or case‑management experience preferred.
• Diploma or degree in nursing from a college or university.

• Clinical knowledge base in medical/surgical nursing or critical care.
• Strong organizational, time‑management, problem‑solving, and critical‑thinking skills.
• Ability to work independently and as part of a team under supervisor guidance.
• Effective verbal and written communication abilities.
• Proficiency in reviewing and interpreting medical records.
• Familiarity with Meditech, Allscripts Care Management, fax, copier, and basic computer skills.
• Knowledge of governmental and insurance guidelines related to case‑management compliance, reimbursement, DRG system, and Interqual criteria.
• Positive attitude with willingness to learn new processes and adjust to change.

• Consistently set priorities and manage time efficiently within scheduled shifts.
• Review patients within 24 hours or next business day after admission and at least every two days thereafter, applying Interqual criteria and facilitating reimbursement with third‑payer parties.
• Complete initial assessments and status revisions within 24 hours or next business day, documenting in Meditech/Allscripts.
• Maintain precise, timely, and appropriate documentation in Allscripts and Meditech; keep legible hard‑copy face sheets.
• Maintain knowledge of patient clinical condition, plan of care, discharge plan, and payer information as demonstrated in group and individual discussions.
• Deliver Initial and Follow‑up Important Message Notifications per departmental policy for 75% of assigned patients.
• Assist in patient conversations regarding discharge choices and appeals, actively facilitating the Discharge Appeals process.
• Initiate peer‑to‑peer and initial appeal processes, communicating clearly with physicians and denials/appeals coordinators within 24 hours or next business day.
• Complete all steps of the code 44 process after referral to EHR for patients not meeting admission criteria, ensuring correct status entry and documentation in Meditech, BAR, and condition code.
• Notify physicians, social workers, and patients of NOTA status with delivery of ABN, HINN‑1, or HINN‑10 when applicable.
• Collect and enter avoidable days, saved days, and denied days in Allscripts, reporting trends to Director/Manager.
• Required weekend rotation; telephone and computer use for extended periods; ability to walk/stand up to two hours/day; clear legible handwriting and understandable voice.

• Medical, Dental, and Vision coverage
• Paid Time Off (PTO)
• Retirement matching
• Tuition reimbursement
• Discount programs
• Flexible Spending Account (FSA)
• Identity theft protection
• Legal aid

Williamson Health is an equal‑opportunity employer and a drug‑free workplace.