Registered Nurse (RN) - Case Manager PRN

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 decisions 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.
• Coordinates 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.

Requirements

• 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 work experience: 1-3 years in Case Management experience preferred.

Qualifications

• Accurately performs patient assessments and identifies patient needs.
• Identifies and initiates appropriate nursing interventions.
• Provides care appropriate to condition and age of the patient.
• Completes and revises the Interdisciplinary Care Plan for each patient.
• Performs timely and accurate QI assessments.

Skills

• Excellent communication and collaboration skills.
• Strong problem-solving abilities.
• Knowledge of healthcare regulations and standards.
• Proficiency in utilizing electronic medical records (EMR).
• Ability to manage multiple tasks and priorities.

Benefits

Frye Regional Medical Center offers competitive benefits including:

• Health insurance coverage.
• Patient assistance programs.
• Employee assistance programs.
• Retirement savings plans.
• Professional development opportunities.

Pay

The pay range for this position is $45,000 - $60,000 annually.

Schedule

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

How you'll contribute

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

• Accurately performs patient assessments and identifies patient needs.
• Identifies and initiates appropriate nursing interventions.
• Provides care appropriate to condition and age of the patient.
• Completes and revises the Interdisciplinary Care Plan for each patient.
• Performs timely and accurate QI assessments.

More about Frye Regional Medical Center

Frye Regional Medical Center is a 355-bed hospital offering acute care hospital, home to the Frye Regional Brain Center, Heart Center, Cancer Center, Emergency Services, General and Vascular Surgery, Orthopedics, Surgical Weight Loss, Women's Birthing Center and Inpatient Rehabilitation that has been offering exceptional care to the Hickory NC community since 1911. We are proud to be recognized by U.S. News & World Report as a High Performing Hospital.

What we're looking for

Applicants should have a current state RN license.