Jennie Stuart Health is seeking a dedicated Case Management Nurse to join our healthcare team on a PRN basis. This role is integral to our patient care system, coordinating services through a multi-disciplinary process that provides both clinical and psychosocial support throughout the continuum of care. The Case Management Nurse will be based at our Medical Center location, working in a mid-career level position with an hourly compensation ranging from $23.02 to $35.97.

As a Case Management Nurse at Jennie Stuart Health, you will be responsible for developing, planning, coordinating, and administering activities related to clinical review, discharge planning, resource utilization, and utilization review. Your primary goal will be to ensure quality, cost-effective care for our patient population, embodying the core values of patient advocacy, holistic assessment, care planning, and empowerment of patients and families.

In this role, you will build collaborative relationships with staff, peers, and physicians while communicating with clarity, integrity, and purpose to optimize healthcare outcomes. You will assess the medical necessity of all admissions, validating the need for hospitalization under the correct patient status, and competently evaluate the needs of patients and their families from admission throughout their hospital stay.

A critical aspect of this position involves proactive discharge planning beginning on the day of admission, which includes patient/family education and the development of safe, quality-driven post-discharge plans. You will collaborate with the multi-disciplinary team to develop and implement appropriate discharge plans for assigned patients and assist in monitoring and evaluating patient/family progress according to established goals.

As our Case Management Nurse, you will serve as an effective liaison between our facility and payers to optimize patient/family reintegration into the community. You will coordinate the integration of various social services into all aspects of patient care and ensure documentation requirements meet facility, state, and federal guidelines. Your documentation should reflect psychosocial and medical background, including high-risk screenings related to case management and proposed interventions/outcomes.

This position requires creative problem-solving skills, utilizing innovation and a team approach. You will need to demonstrate clinical judgment to determine appropriate interventions addressing patient needs and barriers to patient progression through the continuum. A thorough understanding of CMS regulations and other payer processes supporting authorization and identification of correct patient types (Inpatient, Observation, and Outpatient) is essential.

You will collaborate with Social Workers on complex cases to ensure successful discharge plans, consult with providers for care as needed, and make referrals for identified continued care needs. Additionally, you will support chart audit functions including RAC and third-party requests, and assist in identifying department interventions and priority expectations to improve case management metrics such as length of stay reduction, readmission reduction, and discharge times.

As a valued team member, you will practice autonomously, consistent with practice standards, policies, and procedures, escalating cases as needed to the Physician Advisor for intervention. You will provide excellent customer service and hand-off communication while participating in department and organizational performance improvement activities. Above all, you will demonstrate commitment to the mission, vision, and values of Jennie Stuart Health.

This is a regular/at-will position with no travel requirements or per diem allowance.

• Strong clinical and communication skills
• Working knowledge of Medicare/Medicare Advantage, Medicaid, Commercial, and third-party reimbursement processes
• Proven organizational and problem-solving skills
• Excellent customer service skills
• Strong commitment to teamwork
• Experience with InterQual criteria
• Understanding of utilization management
• Knowledge of CMS regulations
• Ability to work autonomously
• Documentation skills meeting facility/state/federal guidelines
• Current BLS Certification
• Kentucky State Nursing License

• Minimum three years acute care experience
• One year in Case Management
• Graduate from an accredited nursing program
• Associate degree in Nursing required (Bachelor's degree in Nursing preferred)
• ACM or CCM Certification preferred
• Experience with discharge planning
• Experience with patient/family education
• Experience with multi-disciplinary collaboration
• Experience with healthcare resource utilization
• Experience with patient advocacy