Case Management Nurse

4 weeks ago

Hartford CT United States Cross Country Search Full time

RN - Health Information & Quality Nurse Manager

Full-time, Mon-Fri, business hours (Hybrid)

Industry leading benefits offered

Competitive compensation package



Responsibilities:

  • Manager is responsible for planning, directing, coordinating, evaluating, and supervising the staff engaged in the quality of care reviews on all services, compliance with policies, regulatory guidelines, high quality and production standards accuracy, and resolution of coding discrepancies.
  • Collaborates with clinical leadership and coding manager to resolve DRG coding and documentation discrepancies, clinical disparities education and training needs for physicians, clinical documentation team and coding staff.
  • Identifies opportunities for improvement by studying the variances form policies and practices. Prepares reports to leadership as opportunities for improvement.
  • Monitors documentation and coding of staff for compliance and regulatory standards; identifies variances from practice and policy and opportunities for improvement.
  • Keeps abreast of changing trends, regulations and technology related to documentation, coding, and reimbursements.
  • Collaborate with interdisciplinary teams including, but not limited to, denials management, Utilization management, Quality and Case Management.
  • Assists with strengthening technical coding practices and clinical documentation by reviewing patient records with flagged complications (i.e., patient Safety Indicators (PSI) to ensure that coding accurately reflects the patient's clinical course and complexity for accurate risk adjustment used in government incentive/penalty programs.


Must Haves:

  • Licensed Registered Nurse in the state of CT with 3+ years of inpatient case management, utilization review, clinical documentation improvement, and some quality assurance / improvement
  • Bachelor of Science Degree in Nursing required; MSN or Master's in HIM preferred
  • Must live in Connecticut
  • Prior lead, supervisor or manager experience
  • Certifications can be obtained within one year of employment - CCDS or CDIP

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