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Manager of Case Management RN
2 months ago
Introduction 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.
Benefits Las Palmas Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- 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
- 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
- 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
- Consumer discounts through Abenity and Consumer Discounts
- Retirement readiness, rollover assistance services and preferred banking partnerships
- Education assistance (tuition, student loan, certification support, dependent scholarships)
- Colleague recognition program
- 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.
Note: Eligibility for benefits may vary by location.
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.
Job Summary and Qualifications
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 proactively ensure that required clinical justification is provided to third-party payers to obtain recertification for continued hospitalization and treatment and that transfer of this information, together with days approved and contact information is provided timely to the PAS and CVO via computerized insurance review documentation.
- 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 educate patient and family on case manager role and process for contacting the case manager for questions.
- 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 ensure that patient tests are appropriate and necessary and are carried out within the established time frame and that results are promptly available. You will serve as a patient advocate by enhancing a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
- 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 initiate delivery of notices of non-coverage as appropriate.
- You will review all new admissions daily against inpatient screening criteria and communicate necessary changes in status designation to ordering physician and Patient Access.
- You will identify all observation patients with an observation alert sticker, reviews status no less frequently than daily, and communicate directly with the attending physician if severity of illness and intensity of service meet the criteria for inpatient admission or when observation hours threaten to exceed 48 hrs.
- You will communicate with treating physicians at regular intervals throughout the hospitalization of the patient to develop an effective working relationship while assisting physicians to maintain appropriate costs, utilization of resources, and discharge plans commensurate with the patient's available resources.
- 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 monitor and provide documentation of identified variance days for tracking and trending.
- 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 delivery of Patient Information and Choice Letter to assure documentation of patient/family involvement with discharge planning and choice of post-discharge service providers. 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.
- RN licensure in the state of TX or Compact State.
- Associates Degree or BSN completion within 3 years of hire date
- 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. Government and non-governmental payers).
Las Palmas Medical Center is a 300+ bed full-service hospital in El Paso. It is home to the region's only kidney transplant center . 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 . click apply for full job details
