Case Manager in Lebanon, KY at Spring View Hospital

Date Posted: 5/2/2021

Job Snapshot

Job Description

Spring View Hospital

Under the supervision and/or direction of the Case Management Director, the Registered Nurse is responsible for the delivery of nursing care consistent with the treatment plan.  Additionally, he/she is responsible for concise documentation for an assigned group of patients, attends treatment team and facilitates groups and recreational therapy. RN may be required to provide direct patient care within the scope of their nursing licensure.

Utilization review nurse provides administrative support for scheduling, admitting, medical records and discharge planning. Completes insurance reviews, obtains insurance prior authorizations and utilizes MorCare to enter patient clinical daily. Will be trained on intake/inquiry process; E request; Denial management; chart reviews for completeness; and certification forms. Performs chart review to identify actual or potential issues with service delivery, patient outcomes and satisfaction, compliance, cost, and reimbursement. Consults with nursing staff and multidisciplinary team regularly to evaluate patient's status and appropriateness of medical care, including admission, length of stay, transfer and discharge. Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Ability to communicate and educate providers on documentation for chart completeness, medical necessity for admission and continued stay, course of treatment, and insurance requirements. Critical thinking skills in order to identify potential harms, value based purchasing, best practice of care, and escalation and implementation of quality measures.

Job Requirements

  • Graduate of a Registered Nurse program, with current licensure in the State of Kentucky.
  • Certification in area of specialty preferred.         
  • One to two years clinical experience preferred.
  • One year in utilization, quality, or case management is preferred.            
  • CPR certification required.
  • ACLS certification recommended.

LifePoint Health is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law.

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