HCA, Hospital Corporation of America Case Management Utilization Review Nurse - Full Time in Las Vegas, Nevada

Now celebrating more than 55 years in the community, Sunrise Hospital & Medical Center provides the most comprehensive, quality healthcare in Southern Nevada. As Las Vegas' largest acute care facility, Sunrise provides sophisticated inpatient and outpatient services to the community. Sunrise Hospital & Medical Center has been recognized with the following awards and accreditations: * Consumer Choice Award recipient for 15 consecutive years * Joint Commission Accredited * American Stroke Association's Get With The Guidelines (GWTG) Gold Plus Performance Achievement Award * CARF Accredited Rehabilitation Unit * Nursing Professionals Top 100 Hospitals to Work For Join us as we achieve our Mission Statement:

/Sunrise Hospital & Medical Center and Sunrise Children's Hospital are dedicated to providing an unparalleled level of measurable quality in the delivery of cost-effective, integrated healthcare services that are responsive to the needs of our patients, physicians, employees, and community. ///

* * *CASE MANAGEMENT UTILIZATION REVIEW NURSE - FULL TIME DAYS* * * *POSITION SUMMARY:* * *

The RN Case Manager/Utilization Review Nurse is responsible for assessing discharge-planning needs for the patients to coordinate the delivery of healthcare services in conjunction with nursing, physicians, ancillary hospital departments, patients and families, and to identify and coordinate post-hospital needs of all patients, infant through geriatrics, in order to promote quality, continuity of care and safety for the patient.

  • This position will facilitate to meet those needs, to facilitate timely and appropriate discharges from the hospital, and to identify opportunities for improvements in patient care.
  • The RN Case Manager/Utilization Review Nurse will facilitate Care Coordination through the IDT (Interdisciplinary Team) rounds.
  • The RN Case Manager/Utilization Review Nurse will act as a patient advocate, investigate all adverse occurrences, perform staff education related to utilization of resources, discharge planning, and psychosocial aspects of healthcare delivery. In addition, the RN Case Manager/Utilization Review Nurse must provide documentation of all functions as required by regulatory agencies. He/she will monitor utilization of resources, track any avoidable days identified, provide clinical reviews in a timely manner utilizing InterQual criteria, and follow review protocols for the department.
  • The RN Case Manager/Utilization Review Nurse would determine the medical necessity for all admissions and need for continued stay, as well as be able to status the patient in the correct level of care – Observation VS. Admission.

_MINIMUM QUALIFICATIONS:_



EXPERIENCE: * Minimum ofthree(3)yearsof clinical experience in nursing; Minimum ofone(1)*yearsin acute hospital case management and utilization review for Medicare, Managed Care and Commercial payors.

Must have knowledge of Interqual. Must have demonstrated prior job interactivity with multiple departments, disciplines and physicians, as well as organizational levels. Must have knowledge of DRGs and GMLOS.


*CERTIFICATION: * Case Management Certification (CCM) or CPUR (Certified Professional Utilization Review) preferred;BLS required.



*LICENSURE: * Current license to practice as an RN in Nevada. Independently maintains license. Maintains required continuing education units to practice and maintain license.

Job: *Case Management

Title: Case Management Utilization Review Nurse - Full Time

Location: Nevada-Las Vegas-Sunrise Hospital and Medical Center

Requisition ID: 01541-14905