Registered Nurse (RN) - Case Manager PRN

Registered Nurse (RN), Clinical Case Manager PRN

Schedule: Monday‑Friday 7:30a.m.–4:00p.m. / 8:00a.m.–4:30p.m.

Job Summary

Your experience matters. Frye Regional Medical Center, part of Lifepoint Health, is a 355‑bed hospital dedicated to providing exceptional care. As a Registered Nurse (RN) and Clinical Case Manager, you will execute, adapt, and oversee care management per the utilization review plan, ensuring resource appropriateness, adherence to geometric length of stay (GLOS), and optimal patient outcomes.

Key Responsibilities

1. Departmental Leadership & Strategic Alignment
   • Assist in developing departmental goals, standards, and objectives aligned with the organization’s strategic plan.
   • Create and foster an environment that encourages professional growth.
   • Integrate evidence‑based practices into operations and clinical protocols.
2. Patient Care Coordination & Quality Oversight
   • Assess the quality of patient care delivered.
   • Coordinate services with patients, staff, physicians, and other departments.
   • Work with interdisciplinary teams to facilitate decision‑making aligned with care plans and patient/family wishes.
   • Coordinate care and services within the case‑managed population.
3. Financial & Payer Management
   • Understand payer issues and anticipate opportunities to reduce expenses and capture revenue from admission through discharge.
   • Educate physicians and staff on case‑management standards and regulatory requirements (Joint Commission, OSHA, CMS, HCFA, AHCA).
   • Mentor staff on utilization‑review standards and length‑of‑stay topics.
4. Clinical Assessment & Care Planning
   • Perform patient/family assessments on admission to identify individualized care management needs.
   • Collaborate with nursing staff to plan strategies for care needs requiring nursing expertise.
   • Coordinate care plans and services to integrate patients into the healthcare continuum.
   • Develop, review, and revise care pathways for specific DRGs to meet regulatory requirements and reduce LOS and readmissions.
   • Ensure timely and accurate documentation of care plans and case‑management interventions.
   • Advocate for patients and families throughout the care episode.
5. Interdisciplinary Collaboration
   • Participate in interdisciplinary team meetings.
   • Maintain effective communication with all disciplines.
   • Provide feedback to the healthcare team regarding patient progress and barriers to care.
   • Coordinate changes to the care plan as needed.
6. Utilization Review & Documentation
   • Perform admission and concurrent medical record reviews.
   • Document utilization review per departmental guidelines.
   • Facilitate physician documentation to reflect patient condition, comorbidities, and procedures.
   • Educate patients/families on third‑party payer guidelines and discharge financial implications.
   • Manage denial appeals and chart audit reviews.
7. Case Management
   • Act as gatekeeper for hospital admissions by initiating care in the ED.
   • Encourage use of reimbursable diagnoses and interface with community agencies.
   • Create care plans for high‑utilization patients and redirect to appropriate hospital services.
   • Monitor and manage resource use to prevent extended LOS.
   • Observe ED processes and ensure appropriate level‑of‑care placement.
   • Use EMR and MCG Criteria for utilization management and quality screening.
   • Identify and resolve delays in care and discharge planning.
   • Consult with appropriate departments to expedite care.
   • Apply conflict resolution skills to ensure timely issue resolution.
   • Apply utilization acuity criteria and document findings.
   • Identify at‑risk populations and follow reporting procedures.
   • Refer cases to Physician Advisor or secondary reviewer and follow up as needed.
   • Discuss payer criteria with clinical staff.
   • Manage discharge planning in coordination with social workers.
   • Initiate referrals for home health, hospice, medical equipment, and facility transfers.

How You’ll Contribute

• Accurately perform patient assessments and identify patient needs.
• Identify and initiate appropriate nursing interventions.
• Provide care appropriate to condition and age of the patient.
• Perform timely and appropriate documentation relating to medical necessity in the medical record.
• Be responsible for completion and revision of the interdisciplinary care plan for each patient.
• Perform timely and accurate QI assessments.

Qualifications

• Current state RN license.
• Bachelor’s degree preferred but not required.
• Basic Life Support certification required within 30 days of hire.
• ACMA Certificate highly preferred.
• CCM Certification highly preferred.
• Minimum work experience 1‑3 years; case‑management experience preferred.

EEO Statement

Frye Regional Medical Center is an Equal Opportunity Employer. It is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.