Insurance Case Manager Jobs in Madison, TN (NOW HIRING)

Do you want to join an organization that invests in you as a(an) RN Case Manager? At TriStar Skyline Medical Center, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

The RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. The RN Case Manager facilitates the progression and transition of care using established criteria and in conjunction with the multidisciplinary team. The RN Case Manager will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization.  

What you will do in this role: 

• Provides case management services for both inpatient and observation patients as assigned.  

• Identifies patients who are at risk for adverse outcomes during the transition from one level of care/setting to another.  

• Performs a comprehensive assessment of psychosocial, medical and discharge needs of patients/family along with an assessment of resources appropriate and available to the patient/family.  

• Reassesses the patient’s clinical condition as indicated. Considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources.  

• Coordinates the plan of care and drives the discharge plan by collaborating with the multidisciplinary health care team and in particular with the patient's physician to facilitate a successful care transition.  

• Partners with Social Services to ensure the post-acute medical needs and level of care are appropriate.  

• Assumes responsibility for timely referral to Social Services when risk factors for psychosocial determinants of health are identified.  

• Involves patient and family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals.  

• Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established chain of command.  

• Makes appropriate referrals to third party payer and disease and case management programs for recurring patients and patients with chronic disease states.  

• Facilitates patient throughput with an ongoing focus on an effective care transition, quality, and efficiency.  

• Documents professional recommendations, discharge plan, care coordination interventions, and case management activities to effectively communicate to all members of the health care team.  

• Aligns patient needs with available resources to ensure a safe discharge/transition.  

• Practices and adheres to the “Code of Conduct” and “Mission and Value Statement”  

 What qualifications you will need:   

• RN License (required)  

• Associate Degree in Nursing or Nursing Diploma (required)  

• Bachelor’s Degree in Nursing (preferred)  

• 2+ years’ experience in case management OR 3+ years’ experience in clinical nursing (required)  

• InterQual experience (preferred)  

TriStar Skyline Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

TriStar Skyline Medical Center is a 250+ bed facility. We are Tennessee's first comprehensive stroke center and a national leader in neuroscience. In addition, we are equipped with 3 helipads, new ICU and Medical/Surgical floors, and burn care services. We offer a CARF accredited Inpatient Rehabilitation program and are an ACS verified Level II Trauma Center. As an Accredited Chest Pain Center with PCI, TriStar Skyline is a leading provider of emergency heart care.

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our RN Case Manager opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.