RN or LPN- Care Management

Join Taylor Regional Hospital and help us uphold our vision of being the preferred healthcare provider, dedicated to enhancing the quality of life in our community.

About the role

The Care Manager is responsible for coordinating and facilitating the delivery of quality, cost-effective, and appropriate healthcare services for patients across the continuum of care. The Care Manager works collaboratively with patients, families, physicians, nursing staff, ancillary departments, insurance companies, community agencies, and other healthcare providers to promote appropriate utilization of services, timely discharge planning, continuity of care, and positive patient outcomes. The Care Manager serves as a patient advocate and assists in identifying barriers to care, coordinating resources, and developing individualized plans to support the patient's healthcare needs.

Responsibilities

• Co-Administrator to the Care Management Director for Interqual CERMe product and performs continued stay assessment on patients. Communicates any failures to attending physician.
• Educates hospital staff (medical, clinical and nursing) to current guidelines of third party payers.
• Continually educates patients, families, hospital staff and medical staff as to the availability and required parameters for inclusion to external resources/services.
• Utilizes level of care guide (InterQual CERMe) to assure appropriate referral to home health, acute rehab, skilled nursing, hospice, acute and/or long term non-skilled DME company or assisted living facility.
• Identifies the need for a Hospital Issued Notice of Non-Coverage (HINN). When necessary to issue HINN, notifies the patient's physicians and appropriate business office staff. Follows through with issuance of HINN per Medicare guidelines.
• Collaborate with coding, billing, therapy, nursing, and providers to optimize reimbursement while maintaining compliance.
• Performs review and evaluation of observation status patients to determine physician orders and patient registration status are consistent and communicates discrepancies to physician and/or staff any clarifications to be made.
• Maintain patient confidentiality in accordance with HIPAA regulations.
• Performs other duties within the realm of Care Management departmental responsibilities, as requested.

Requirements

• RN: Associate Degree in Nursing required; Bachelor's preferred.
• LPN: Graduate of an accredited practical nursing program with a diploma or certificate in Practical Nursing.
• Valid KY RN or LPN License.
• 1-2+ years of nursing experience preferred.
• Strong clinical assessment and critical-thinking skills appropriate to licensure.
• Excellent verbal and written communication skills.
• Strong organizational and time-management skills.
• Knowledge of healthcare resources and community services.
• Frequently sits, stands, walks, and bends.
• BLS required through American Heart Association; renewals are included with TRH employment.

Benefits

• Full-Time Benefits Eligible
• Competitive pay
• Tuition reimbursement
• Hospital Funded Pension Plan
• Comprehensive Benefit Package
• 30% off in the TRH Cafe

Schedule

32 hours per week, day shift.