Registered Nurse (RN) - Case Manager

About the role

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're embracing a vital mission dedicated to making communities healthier.

Responsibilities

• Assists in developing departmental goals, standards, and objectives aligned with the organization's strategic plan and vision.
• Creates and fosters an environment that encourages professional growth.
• Integrates evidence-based practices into operations and clinical protocols.
• Affirms the quality of patient care delivered and coordinates services with patients, staff, physicians, and other departments.
• Works with interdisciplinary teams to facilitate decision-making aligned with care plans and patient/family wishes.
• Coordinates care and services within the case-managed population.
• Understands payer issues and anticipates opportunities to reduce expenses and capture revenue from admission through discharge.
• Educates physicians and staff on Case Management standards and regulatory requirements (Joint Commission, OSHA, CMS, HCFA, AHCA).
• Mentors staff on Utilization Review (UR) standards and Length of Stay (LOS) topics.
• Performs patient/family assessments on admission to identify individualized care management needs.
• Collaborates with nursing staff to plan strategies for care needs requiring nursing expertise.
• Carefully coordinates care plans and services to integrate patients into the healthcare continuum.
• Develops, reviews, and revises care pathways for specific DRGs to meet regulatory requirements and reduce LOS and readmissions.
• Ensures timely and accurate documentation of care plans and Case Management interventions.
• Advocates for patients and families throughout the care episode.
• Participates in Interdisciplinary Team Meetings.
• Maintains effective communication with all disciplines.
• Provides feedback to the healthcare team regarding patient progress and barriers to care.
• Coordinates changes to the care plan as needed.
• Performs admission and concurrent medical record reviews.
• Documents utilization review per departmental guidelines.
• Facilitates physician documentation to reflect patient condition, comorbidities, and procedures.
• Educates patients/families on third-party payer guidelines and discharge financial implications.
• Manages denial appeals and chart audit reviews.
• Acts as gatekeeper for hospital admissions by initiating care in the ED.
• Encourages use of reimbursable diagnoses and interfaces with community agencies.
• Creates care plans for high-utilization patients and redirects to appropriate hospital services.
• Makes sure resource use is managed to prevent extended LOS.
• Observes ED processes and ensures appropriate level-of-care placement.
• Uses EMR and MCG Criteria for utilization management and quality screening.
• Identifies and resolves delays in care and discharge planning.
• Consults with appropriate departments to expedite care.
• Applies conflict resolution skills to ensure timely issue resolution.
• Applies utilization acuity criteria and documents findings.
• Identifies at-risk populations and follows reporting procedures.
• Refers cases to Physician Advisor or secondary reviewer and follows up as needed.
• Discusses payer criteria with clinical staff.
• Manages discharge planning in coordination with Social Workers.
• Initiates referrals for home health, hospice, medical equipment, and facility transfers.

Qualifications

• A current state RN license.
• Bachelor's degree preferred but not required.
• Basic Life Support certification is required within 30 days of hire.
• ACMA Certificate highly preferred.
• CCM Certification highly preferred.
• Minimum 1-3 years Case Management experience preferred.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage - with medical plans starting at just $10 per pay period - tailored benefit options for part-time and more.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

Pay

Commensurate with experience.

Schedule

Full Time - Monday-Friday 7:30a-4:00p/8:00a-4:30p