HCA, Hospital Corporation of America RN Case Manager in Richmond, Virginia

At Johnston-Willis Hospital, we have been delivering top quality healthcare to Greater Richmond and the Tri-Cities area for more than 100 years, which means you can depend on our experience to provide the exceptional care you need. Our 292-bed hospital offers a full range of healthcare services, with specialties in cancer care—through the Thomas Johns Cancer Hospital—as well as inpatient rehabilitation (with all private rooms), our ER is a state-authorized level III trauma center and neuroscience, including our first-in-Richmond Gamma Knife Center. The RN Case Manager will:

  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.

EXPERIENCE

Required: Five years of recent clinical experience.

Preferred: Commercial Utilization Management and/or Case Management experience; Case Management Experience.

EDUCATION

Required: Registered Nurse

Preferred: B.S.N.

Title: RN Case Manager

Location: Virginia-Richmond-Johnston-Willis Hospital

Requisition ID: 00035-34587