Registered Nurse - Case Manager/Utilization Review - Part Time Days
Company: Williamson Health
Location: Nashville
Posted on: January 7, 2026
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Job Description:
Summary ABOUT WILLIAMSON HEALTH | Williamson Health is a
regional healthcare system based in Williamson County, Tennessee,
with more than 2,300 employees across more than 30 locations and
more than 860 physicians and advanced care practitioners offering
exceptional healthcare across 60-plus specialties and
subspecialties close to home. The flagship facility, Williamson
Medical Center, which recently opened its new Boyer-Bryan West
Tower, offers extensive women's services, state-of-the-art
cardiology services, advanced surgical technologies, an
award-winning obstetrics and NICU, leading-edge orthopaedics,
outpatient imaging services, and distinct comprehensive emergency
and inpatient services for both adult and pediatric patients. Other
Williamson Health service providers include the Bone and Joint
Institute of Tennessee, The Turner-Dugas Breast Health Center,
Monroe Carell Jr. Children's Hospital Vanderbilt at Williamson
Medical Center, Williamson Health physician practices that are
strategically located throughout the community, countywide
Emergency Medical Services that include 18 rapid response units,
Williamson Health Foundation, and multiple joint venture Vanderbilt
Health and Williamson Medical Center Walk-In Clinics in Williamson
County. Learn more about our many specialized services at
WilliamsonHealth.org. Williamson Health is a system where your
talents will be valued and your skillset expanded. We are rooted in
our promise to world-class, compassionate care for the residents of
Williamson County and surrounding communities, taking exceptional
pride in serving our community. We're committed to empowering our
employees to work in innovative ways and reserve time and space for
curiosity, laughter and creativity. We value and support the
diversity and cultural differences among one another and are
committed to upholding an inclusive environment that appreciates
the uniqueness of all individuals. Our values are at the heart of
everything we do: respect for every individual, the health and
total well-being of all people, human compassion and integrity.
These shape who we are as an organization and are essential for
delivering the highest level of culturally competent care and
treatment of every patient, family member, visitor, physician and
employee. Williamson Health is pleased to offer a comprehensive
benefits program, that offers you choice and flexibility, so you
can take charge of your physical, financial, and emotional
well-being. o Medical, Dental, Vision o PTO o Retirement Matching o
Tuition reimbursement o Discount programs o FSA (Flexible Spending
Accounts) o Identity Theft Protection o Legal Aid Williamson Health
is an equal-opportunity employer and a drug-free workplace.
POSITION SUMMARY To perform the activities of Case Management and
Utilization Management to facilitate the collaborative management
for an entire episode of care for all patients with the
multidisciplinary health care team, focusing on resource management
and discharge planning. Performs timely review and delivery of
necessary clinical information according to governmental
regulations and insurance guidelines for approval of hospital care
and correct admission status optimizing appropriate reimbursement
for services, while supporting the mission of Williamson Health.
POSITION REQUIREMENTS Formal Education / Training: 1. Must be
currently licensed by the State of Tennessee as a Registered Nurse.
2. Emergency Room and or Critical Care preferred 3. Case Management
Certification preferred/required within 3 years of employment 4.
Earned a nursing diploma or degree from a college or university
Workplace Experience: Recent minimum 5 years related experience in
hospital or managed care setting. Prior utilization/case management
experience is preferred. Equipment and Skills Training:
Demonstrated clinical knowledge base in medical/surgical nursing
and or critical care. Demonstrated organization, time management,
problem-solving and critical thinking skills. Able to perform
independently and in team situations under the supervision of a
Director/Manager. Demonstrated effective verbal and written
communication skills. Efficient review and interpretation of the
medical record. Familiar with Meditech, Allscripts Care Management,
Fax, Copier, basic computer skills preferred. General knowledge of
Governmental and Insurance guidelines related to case management
compliance, reimbursement, DRG system and Interqual Criteria
preferred. Positive attitude with a willingness to learn new
processes and adjusts well to change. Required Weekend Rotation
Physical Environment: Office and Clinical environment. Possible
exposure to airborne pathogens. Physical Effort: Telephone and
computer use for extended periods of time. Able to walk/stand, up
to 2 hours/day. Clear legible handwriting Clear understandable
voice. PERFORMANCE STANDARDS 1. Consistently sets priorities and
exhibits efficient time management skills with assigned workload
within the confinements of scheduled shift. 2. Timely reviews
patients within 24 hours or next business day after admission and
at a minimum of every 2 days thereafter for continued stay,
applying appropriate criteria (Interqual®) and facilitating
reimbursement for services with third payer parties, obtaining and
entering authorization number/approval status and notes in
Meditech. 3. Completes assessments and initial status revision
within 24 hours or next business day, documenting in
Meditech/Allscripts. 4. Maintains precise, timely, and appropriate
documentation in Allscripts and Meditech. Maintains legible,
pertinent documentation on the patient's hard copy face sheet 5.
Maintains knowledge of assigned patient's clinical condition, plan
of care, discharge plan and payer source information as
demonstrated in group and individual discussions 6. Timely delivery
of the Initial and Follow-up Important Message Notification
according to departmental policy for 75% of assigned and
appropriate patients. 7. Assists in patient conversations and
delivery of information related to discharge choices/discharge
appeals and actively facilitates in the Discharge Appeals process.
8. Initiates peer to peer and initial appeal process as shown by
consistent, clear communication to the physician and
denials/appeals coordinator within 24 hours or next business day of
notification of denial and documentation in Meditech/Allscripts
&/or BAR. 9. Accurate and timely completion of all steps of the
code 44 process after referral to E HR for those patients not
meeting admission criteria. Complete documentation which includes
hard copy forms, ensuring the status order is entered and correct
in the Medical Record followed by documentation in Meditech, BAR
and condition code is entered. 10. Timely notification to
Physician, social worker, and patient of NOTA status with delivery
of ABN, HINN-1 or HINN-10 when appropriate 11. Collects and enters
avoidable days, saved days and denied days in Allscripts, reporting
trends to Director/Manager
Keywords: Williamson Health, Nashville , Registered Nurse - Case Manager/Utilization Review - Part Time Days, Seasonal Jobs , Nashville, Tennessee
