HCA, Hospital Corporation of America Case Mgr in Las Vegas, Nevada
The Registered Nurse (RN) Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge. The tasks and responsibilities include: * Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes. * Assesses and responds to patient/family needs by coordinating efforts of other team members. * Identifies and resolves barriers that hinder effective patient care. * Collaborates and consults with physicians on patient's progress and discharge planning needs. * Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity. * Manages the process to review and, as appropriate, appeal denials received from payers. * Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient. * Maintains knowledge of resources and facilities available to patients and family members. * Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions. * Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities. * Provides age and culturally appropriate care. * Orients and mentors new staff members.
QUALIFICATIONS: * Current licensure as a registered nurse (RN). * Graduate of an accredited school of professional nursing. Bachelors of Science in Nursing preferred. * CCM preferred * Minimum 2 years of Acute Care case manager experience * Knowledge of CMS guidelines and experience working with payer specific guidelines and contractual rules preferred. * Customer service abilities including effective listening skills. * Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines. * Assertive and persuasive communication skills, action oriented.
Title: Case Mgr
Location: Nevada-Las Vegas-MountainView Hospital
Requisition ID: 02270-7039