HCA, Hospital Corporation of America Case Mgr in Richmond, Virginia
_SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS**_* · Applies the rules of Severity of Illness, Intensity of Service, and Discharge Screens/Indicators consistently in evaluating medical necessity. · Performs admission and concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan.
· Educates patients and families to the patient’s needs post discharge and informs them of the alternatives available to meet those needs.· Refers patients who require extended care post discharge to long term care facilities. Once an appropriate bed is located, arranges for the patient’s transfer
· Collaborates with community agencies to provide services to assist with housing, financial, transportation, psychosocial, educational, home health, and home medical equipment needs of patients/families post discharge.
· Initiates patient/family conference with the health care team to achieve positive outcomes.· Identifies, tracks, and records Alternative Care Days (ACDs). Intervenes to prevent or decrease ACDs as appropriate. · Initiates denial and appeal process in accordance with policy. Refers HINN letters to Director. · Maintains knowledge base for identification and reporting of potential patients with contractual adjustment needs and length of stay issues. · Provides crisis and supportive counseling to enhance the patient’s and family’s problem solving and coping skills. Counsels patient/families regarding advance medical directives. · Takes a proactive role in discharge planning. · Maintains knowledge base with an awareness of current trends that influence health care practice
_EXPERIENCE_ · Required: Five years of recent clinical experience as RN. · Preferred: Commercial Utilization Management and/or Case Management experience; Quality Management Experience.
EDUCATION· Required: Registered Nurse with current Virginia licensure. · Preferred: B.S.N.
Title: Case Mgr
Location: Virginia-Richmond-Henrico Doctors Hospital Forest
Requisition ID: 00448-34539