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.


· 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