Category:
RN Professional
City:
Martin
State:
Tennessee
Shift:
8 - Day (United States of America)
Job Description Summary:
Provides leadership in the coordination of patient-centered care across the continuum, develops a secure discharge plan through collaboration with the patients / caregivers and multidisciplinary healthcare team to arrange appropriate post discharge services and optimal transitions in care. Facilitates appropriate LOS, patient satisfaction, and reimbursement for all patients. Develops and maintains collaborative relationships with all members of the healthcare team. Through clinical care coordination drives efficient utilization of resources to reduce length of stay, improve patient flow and throughput, limits variation by applying innovative and evidence based practice, and to reduce the risk of readmission.
ESSENTIAL JOB FUNCTIONS:




Obtains or ensures acquisition of appropriate pre-certifications authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party payer guidelines
Obtains or facilitates acquisitions of urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements
Documents, monitors, intervenes/resolves, and reports clinical denials/appeals and supports retrospective payer audit denials; collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor, and third party payers, etc.
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.; serves as an educational resource to all WTH staff regarding utilization review
Assumes roles in assessment physical, psychosocial, & economic needs for transition of care planning

📌 Care Management Case Managers (Dhamtari)
🏢 West Tennessee Healthcare
📍 Dhamtari