PRN RN Case Management in Pulaski, TN at Southern Tennessee Regoinal Health System- Pulaski

Date Posted: 2/13/2020

Job Snapshot

Job Description

Southern Tennessee Regional Health System - Pulaski


Analyzes patient records to determine legitimacy of admission, treatment and length of stay in health care facility to comply with government and insurance company reimbursement policies by performing the duties required through personally or through subordinate supervisors.

Evaluate each Inpatient and Outpatient case within 24 hours of admin to assure appropriate physician order and other documentation to support the appropriate level of care for the patient based upon criteria set for the my CMS and by Commercial Insurance Companies.

Assure appropriate insurance authorizations as needed.

Work with Medical Staff to educate and facilitate required documentation to support the appropriate level of care for each patient, including participation in the Clinical Documentation Program.

Facilitate Discharge Planning through team collaboration for each patient that includes services required post discharge such as Home Health, Outpatient Therapies or Skilled Nursing Care including Swing Beds and education regarding that care.

Documents actions taken to evaluate and facilitate the Case Management review and discharge planning process.

Participate in statistical tracking and reporting of the Utilization Management metrics.

Facilitates appeals of denials as needed, including analysis and corrective actions for denials due to those processes within the scope of the Case Management functions.

Reports to the Director of Quality/Risk.

Job Requirements

Minimum Education

Current RN license in the State of Tennessee.


Current Tennessee RN license

Required Skills

Basic computer skills.

High level interpersonal skills with the ability to handle sensitive and confidential information.

Position requires the ability to work with patients and families in order to achieve appropriate continuum care for the patient.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran

LifePoint Health - (615) 920-7000

330 Seven Springs Way, Brentwood, Tennessee 37027

© 2018 LifePoint Health, Inc.

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