Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
- Utilization Review
- Discharge planning
- Readmission Reduction Participation
- Payer Communication and denial reduction
- Completes assigned goals.
Specifications
Experience
Minimum Required
- RN with at least one (1) year of clinical experience
Preferred/Desired
- RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
- Diploma or Associate Degree in Nursing
Preferred/Desired
- BSN or MSN
Training
Minimum Required
Preferred/Desired
- Certified Case Manager
Special Skills
- .
Minimum Required
- Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
- Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
- RN
Minimum Required
- RN
Preferred/Desired
- RN;CCM;ACM
Skills Required
- Registered Nurse (RN) license
- Minimum 1 year of clinical nursing experience
- Diploma or Associate Degree in Nursing
- Critical thinking, communication, organization, interpersonal and computer skills
- 3 years clinical experience with Case Management in hospital or payer setting
- BSN or MSN
- Certified Case Manager (CCM) or ACM
- Knowledge of payer requirements and governmental regulations
What We Do
Baptist Memorial Health Care is one of the country’s largest not-for-profit health care systems and the largest provider of Medicaid in the region. Baptist offers a full continuum of care to communities throughout the Mid-South and consistently ranks among the top integrated health care networks in the country. The health care system comprises 24 affiliate hospitals in West Tennessee, Mississippi and East Arkansas; more than 5,400 affiliated physicians; Baptist Medical Group, a multispecialty physician group with more than 900 providers; home, hospice and psychiatric care; minor medical centers and clinics; a network of surgery, rehabilitation and other outpatient centers; and an education system highlighted by Baptist Health Sciences University (formerly Baptist College of Health Sciences). Baptist employs more than 21,000 people, and in fiscal year 2022 contributed more than $455 million in community benefit and uncompensated care to the communities it serves. For more information, please visit www.baptistonline.org or follow us on Facebook or Instagram.
