Job Description:

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:1
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.2
Assess discharge needs of patients, document in medical record, meet discharge needs, and participate in multidisciplinary team meetings.3
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

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RN Case Manager | Full Time | Chatuge Regional Hospital