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Manager of Medical and Nursing Services RN
3 months ago
Want to join a team of daring managers who care without reservations or limits? Our Las Palmas Medical Center team is looking for a(an) Manager of Case Management RN. HCA Healthcare is an advanced healthcare network that has committed up to $300 million to our incredible team members over the course of three years.
Las Palmas Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
~ Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
~ Free counseling services and resources for emotional, physical and financial wellbeing
~Employee Stock Purchase Plan with 10% off HCA Healthcare stock
~ Family support through fertility and family building benefits with Progyny and adoption assistance.
~ Referral services for child, elder and pet care, home and auto repair, event planning and more
~ Retirement readiness, rollover assistance services and preferred banking partnerships
~ Education assistance (tuition, student loan, certification support, dependent scholarships)
~ Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
~ Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
HCA Healthcare is committed to research and clinical protocols. Do you want to impact standards of care and save lives across the country? Apply today to our Manager of Case Management RN and be a part of the innovation of ideas.
Provides overall coordination in the delivery of medical services and discharge planning for a specified patient population. Performs concurrent and retrospective review of patient medical records for purposes of utilization review, compliance with requirements of external review agencies including governmental and non-governmental payers and quality assurance agencies. Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physicians, funding representatives and community agencies. Ensures continuity in the handoff of patient clinical information from the hospital to other involved healthcare entities. The duties of the acute care Case Manager may be performed as in the integrated or triad model.
You will communicate proactively and cooperatively with Patient Access, Patient Account Services (PAS) and Central Verification Office (CVO) personnel to ensure proper pre-certification and consistency of admissions status designation between physician order and EMR.
You will communicate known changes to patient payer information and other relevant financial characteristics of coverage to appropriate admissions and billing personnel.
You will serve as a liaison between third-party payers, patient access PAS, and CVO to ensure communication of all pertinent information regarding level of care, billing and reimbursement.
You will work with the patient and family to identify alternate financial resources available to meet the cost of necessary post-discharge needs or to recommend alternate care options when necessary funding is unavailable.
You will proactively initiate an expedited appeals process with payers and communicates with denials management regarding anticipated or verified denials and cooperates with denials management to provide additional clinical information for appeals.
You will coordinate the integration of social services/case management functions into the patient care, discharge and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
You will collaborate with clinical staff in the development and execution of the plan of care and achievement of goals. You will facilitate interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identify post-hospital needs.
You will refer to social work cases where patients and/or family would benefit from counseling required to complete complex discharge plans.
You will Conducts concurrent medical record review using specific quality indicators and clinical decision support criteria as approved by the medical staff, TJC, CMS and other regulatory agencies and document findings.
You will serve as liaison with Physician Performance Improvement (PPI) to ensure the reporting of quality indicators and care concerns.
You will ensure physician documentation supports medical necessity and LOC for each inpatient day, educate physicians by aggressively discussing additional documentation needs as identified or discharge plans, and confer with the Case Management Director and Physician Advisor as needed for intervention.
You will stay current with education related to CMS and HCA billing compliance mandates, and monitor and ensure that the facility is compliant.
You will facilitate the delivery of CMS discharge appeals rights communication to applicable Medicare patients within the indicated time frame required by law.
You will provide a retrospective chart review for short-stay inpatients under Medicare for medical necessity and level of care prior to billing.
You will collaborate with the interdisciplinary care team, service liaisons, patient, and family in the assessment and coordination of discharge planning needs, delivery of post-discharge services and transition of the patient from an acute level of care to the discharge setting.
You will facilitate the ordering and delivery of specialized medical equipment, orthotics and prosthetics as ordered by the attending physician.
You will facilitate the referral process of next level of care.
Prefer three-five years clinical experience within an acute health care setting with recent work history in acute care case management role or related health care experience. Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, use of InterQual® or other clinical decision support criteria, discharge planning, and reimbursement structures (i.e. Las Palmas Medical Center is a 300+ bed full-service hospital in El Paso. The facility offers a range of services including emergency care with a Level III trauma center , cardiac care, women’s services, pediatric care and NICU, cancer care, and more. Las Palmas Medical Center is part of Las Palmas Del Sol Healthcare. We are a leading healthcare provider for El Paso and the surrounding region that is part of HCA Healthcare.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"HCA Healthcare Co-Founder Unlock your potential with a leading healthcare provider dedicated to its patients, colleagues and communities. Help guide our team as a(an) Manager of Case Management RN and help us improve more lives in more ways .
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
