What are the responsibilities and job description for the RN - Manager, Patient Resource Mgmt (8a-5p) Johnson City, TN position at Franklin Woods Community Hospital?
Description
Job Description:
Summary:
The RN - Manager, Patient Resource Mgmt serves as the supervisor for the Case Management, Social Work, Utilization Review, and Precertification Departments. The Manager directly supervises all personnel in these departments and is responsible for program development, performance improvement, accreditation preparation, utilization review, and other departmental activities. The RN – Patient Resource Management Manager oversees the precertification process, ongoing recertification, and insurance approval activities.
The Manager is responsible for the tracking and timely appeal of denials throughout Ballad Health facilities. Manager is knowledgeable regarding all payor sources and serves as a resource to the Managed Care and Patient Account Departments working with these departments to ensure proper payment of accounts as well as assisting with contract negotiations.
The RN – Patient Resource Management Manager demonstrates skill in developing and guiding collaborative collegial practice that delivers safe competent care based on meticulous application of the nursing process. Individual demonstrates sensitivity and understanding of the diverse cultural backgrounds of patients and caregivers. The position involves maintaining current knowledge of evidence-based nursing practice and the ability to demonstrate critical thinking skills in the implementation of all phases of the nursing process. This individual actively participates in patient care quality and performance improvement through data collections; aggregation and analysis of relevant key indicators of quality (KIQ's). This commitment to quality results in the development and implementation of action plans to include the monitoring of the effectiveness of improvements.
Requirements:
Associate's or Bachelor's degree from an accredited Nursing program, Master's degree preferred. Five years applicable clinical experience. Five years case management experience. Two years supervisory experience, preferably in case management.
Licenses and Certifications:
Valid and active RN licensure in appropriate stateValid and active Case Management certification
Work Requirements:
Shift: Day
On Call: Yes
Weekends: No
Travel Required: No Travel
Location:
Franklin Woods Community Hospital
