Acute Care Case Manager
Nashville, TN
HumanEdge Travel Healthcare
5x8 hrs, Days

Case Manager Opportunity

Contract Length

• 13 weeks

Job Overview

The Case Manager is responsible for utilization reviews, resource management, discharge planning, treatment plan management, financial management, and medical record documentation.

Key Responsibilities

• Promote patient and employee safety, including safe patient handling and infection control.
• Identify patient problems affecting treatment participation and assist patients/families in utilizing hospital resources.
• Collaborate with interdisciplinary teams to manage clinical plans of care and ensure safe, timely discharges.
• Facilitate patient and family participation in care decisions and discharge planning.
• Refer patients and families to outside agencies for social issues unrelated to healthcare.
• Ensure compliance with payor requirements, insurance certifications, and reimbursement guidelines.
• Conduct utilization reviews and assure medical necessity criteria are met for admissions and continued stays.
• Maintain up-to-date community resource information and assist patients/families in accessing services.
• Work with clinical teams to identify unnecessary tests and procedures.
• Manage outlier patients to optimize outcomes.
• Document plans of care and progress notes according to policy and regulations.
• Participate in team meetings and contribute to facility-wide improvements.
• Maintain fiscal responsibility by ensuring appropriate billing and contract compliance.
• Provide payor-friendly options to promote prompt payments and reduce financial risks.

Required Skills and Qualifications

• Current licensure in a clinical discipline per state guidelines (RN, RT, SW preferred).
• Associate’s Degree in a healthcare field (Bachelor’s degree preferred).
• Working knowledge of the insurance industry and government reimbursement.
• Minimum 2 years of experience in Case Management and Discharge Planning in an Acute Care setting.

Work Environment and Values

• Commitment to superior quality, teamwork, and resourcefulness.
• Strong focus on patient and employee safety.
• Adherence to facility guidelines on appearance, attendance, and punctuality.
• Professional interaction with patients, families, and healthcare professionals to enhance facility reputation.

This role is ideal for healthcare professionals experienced in acute care case management who are committed to patient safety, interdisciplinary collaboration, and efficient resource utilization.