Case Manager / PRN ( RN / RT / SW / LPN )

Select Medical - Nashville, TN

Full-time - Entry Level

Nashville, TN

10,001+ employees

Ambulatory Health Care Services

About the position

The Case Manager (PRN) position at Select Medical involves providing critical care management for patients in a hospital setting. This role requires a current clinical licensure and focuses on discharge planning, utilization reviews, and resource management to ensure quality patient care and compliance with healthcare regulations. The Case Manager will work on an as-needed basis, primarily during weekdays, and will be responsible for coordinating with multidisciplinary teams to facilitate patient recovery and proper reimbursement for services provided.

Responsibilities

• Develops and implements a patient specific, safe and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Builds relationships and coordinates with payor sources to assure proper reimbursement for hospital provided services.
• Demonstrates compliance with facility-wide Utilization Management policies and procedures.
• Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintains fiscal responsibilities and assures the department identifies and negotiates the fullest possible reimbursement for insurance coverage.
• Facilitates multi-disciplinary team meetings including physicians, nurses, respiratory therapists and rehabilitation therapists.

Requirements

• Current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist OR current license/certified Social Work license per state guidelines.
• Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting dealing with critical care/acute care patients.
• Adequate experience in an acute medical case management setting and confidence to manage and direct a plan of care for chronically critically ill populations.

Nice-to-haves

• Specific experience in Care Management and Discharge Planning is preferred.
• Working knowledge of the insurance industry and government reimbursement.

Benefits

• Work-life balance
• Diversity and inclusion initiatives
• Equal opportunity employer