HCA, Hospital Corporation of America RN Case Manager in Richmond, Virginia
1.Review health records for appropriateness of application of 2 Midnight Rule for initial review of all Medicare admissions. Perform continued stay reviews of trauma patients for appropriateness based on InterQual® criteria. 2. *Performs admission and concurrent reviews for all payors and maintains legible documentation as directed by the Utilization Management Plan. 3. *Review of patient notes identifying and addressing any conflict in medical orders or lack of management plan. 4. *Build a rapport by providing continuity of care with patients and acting as their advocate throughout their hospital stay. 5. *Collaborate between multiple care givers and foster communication between medical teams and nursing staff 6.Identifies and intervenes to coordinate care of trauma patients in relation to appropriateness of level of care, length of stay and resource utilization issues. 7.Identifying barriers to discharge and contacting relevant personnel to overcome these. 8.Initiates and monitors referral process of patients post discharge. 9.Identifies, tracks, and records Avoidable Days [AD], intervening to prevent or decrease as appropriate. 10.Initiates denial and appeal process in accordance with policy. 11.Demonstrates awareness of current trends that influence health care practice and assures compliance with professional, regulatory, governmental and organization standards.
C EXPERIENCE Required: Five years of recent clinical experience. Preferred: Commercial Utilization Management and/or Case Management experience; Case Management Experience. C EDUCATION Required: Registered Nurse Preferred: B.S.N.
Title: RN Case Manager
Location: Virginia-Richmond-Johnston-Willis Hospital
Requisition ID: 00035-34587