HCA, Hospital Corporation of America Case Manager Utilization Review Nurse - Full Time in Las Vegas, Nevada
Serving the community for nearly 60 years, Sunrise Hospital and 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 and Medical Center has been selected the Consumer Choice Award recipient for 15 consecutive years and had earned the American Stroke Association’s Get With The Guidelines (GWTG) Gold Plus Performance Achievement Award. We are also ranked Nursing Professionals Top 100 Hospitals to work for!
Case Manager/Utilization Review Nurse - Full Time Days
POSITION SUMMARY : (Includes, but is not limited to):
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.
Must have a wide range of medical knowledge with various types of patient care/services performed in an acute hospital setting.
Must have strong PC skills with current operating systems.
Must have knowledge of Interqual criteria.
Must have critical thinking skills and the ability to obtain and summarize medical information utilizing various reports and computer systems.
Must have knowledge of accreditation standards and compliance requirements, as well as government and non-government payor practices, regulations, standards and reimbursement.
Must have prior insurance review experience.
Must be able to retain a high level of confidentiality.
Works independently and is flexible with all job duties.
Must have outstanding telephonic and personable skills to communicate with various entities, (i.e. physicians, health plans, review nurses, clerical personnel, etc.).
Maintains professional credentialing and continuing education pertaining to job description.
Graduate of an accredited nursing program – diploma, associate degree, or baccalaureate program; BSN preferred.
Minimum of three (3) years of clinical experience in nursing; Minimum of one (1) years in 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
KNOWLEDGE, SKILLS, AND ABILITIES:
Must demonstrate excellent interpersonal, written and verbal skills.
Be well organized and have the ability to prioritize and handle multiple tasks efficiently and independently.
Have demonstrated ability to initiate and follow through with multiple projects.
Must be a self-starter and independent worker with excellent time management skills.
Be able to thrive in a fast-paced, friendly and process-oriented office environment.
Must possess strong PC skills with current operating systems and have strong InterQual criteria knowledge.
Must be able to pass a yearly InterQual criteria exam.
CERTIFICATION : Case Management Certification (or comparable) required. May attain certification within 6 months of start of this position)
Current license to practice as an RN in Nevada. Independently maintains license. Acquires required continuing education units to practice and maintain license.
Job: *Case Management
Title: Case Manager Utilization Review Nurse - Full Time
Location: Nevada-Las Vegas-Sunrise Hospital and Medical Center
Requisition ID: 01541-15689