RN Case Manager

3 days ago

Little Rock, United States Arkansas Heart Hospital Full time
Job Details

Job Location
Arkansas Heart Hospital - Little Rock, AR

Description

Position Summary

The Case Manager Utilization Review utilizes the nursing process for age and diagnosis of specific populations to assess, plan and evaluate the care of a designated case load of patients so that clinical and financial outcomes are achieved. Holds primary responsibility for oversight of Care Coordination and Utilization Review for all patients, providing direction and delegation as appropriate. Responsible for appropriate utilization of medical necessity criteria and provides guidance to medical and other clinical staff in their use.

Work Schedule

Flexible schedules to cover all shifts and weekends, as hospital needs demand.

Primary Duties

Utilization Review:

Maximizes positive financial outcomes for his/her designated case types.
  • Develops and demonstrates organizational skills and effective time management skills on a daily basis.
  • Compares and contrasts resource utilization before and after a planned change.
  • Identifies and implements changes/strategies to improve profitability of targeted case types.
  • Ensures optimization of reimbursement through assignment of proper coding for specific cases.
  • Monitors and analyzes variances from standard and individualized clinical paths.
  • Assesses efficiency and cost effectiveness of interdepartmental systems.
  • Identifies and communicates problems/inefficiencies in interdepartmental operations to the Director, Case Management.
  • Assists the Director, Case Management in planning, implementing and evaluating strategies to correct/improve problems/inefficiencies.
  • Performs and/or delegates admission and continued stay review for all payers and levels of care; performs these responsibilities within 24 hours of admission and continued stay reviews not less than every three (3) days.
Utilizes consistent processes to assure that all patients are evaluated and monitored for appropriate resource consumption.
  • Applies utilization review criteria objectively for admissions, continued stay, level of care and discharge readiness, using Milliman Care Guidelines or other facility criteria guidelines.
  • Screens and coordinates admissions and transfers, including emergency and elective care, observation status, conversions from outpatient to inpatient care and out-of-area transfers.
  • Participates in the investigation and collaborates with the attending physician in case denials and appeal process.
  • Collaborates with the attending physician when the medical record documentation does not reflect admission or continued stay criteria and confers with Case Management Director and/or Medical Director for assistance when consensus cannot be reached with the attending physician.
  • Ensures facility processes for working with external reviewers is followed in a timely and complete manner.
  • Communicates external UR determinations to patient and/or family when applicable.
Participates in the Case Management/Utilization Review Committee formal processes.
  • Collects and aggregates utilization data for tracking and trending reports.
  • Coordinates and maintains data to address issues of over-utilization, under-utilization and admission necessity.
  • Attends CM/UR Committee meetings as assigned.
  • Actively collaborates with CM Medical Director to maximize appropriate and efficient care of patients.
  • Is knowledgeable of and supports the AHH Utilization Review Plan.
  • Assists with coordinating peer review, focused reviews or other studies as directed by the CM/UR Committee
Communicates effectively with patients, families, physicians, staff and other customers.
  • Communicates clearly and accurately in both verbal and written form.
  • Consistently demonstrates tact, diplomacy, sensitivity and professionalism.
  • Exhibits appropriate telephone protocol.
  • Adheres to proper channels of communication in a courteous and cooperative manner.
  • Acknowledges each patient complaint within the shift and takes appropriate action.
  • Greets patients and visitors promptly and makes them feel welcome.
  • Utilizes correct procedure in regard to hospital information systems and communication with ancillary departments.
  • Communicates, coordinates and conducts at a minimum weekly inter-disciplinary health team conferences for individual case types.
Contributes to modifications in nurse and physician practice patterns to continuously improve quality of care, patient satisfaction and appropriate use of resources.
  • Maintains current knowledge of national standards or practice, as well as Joint Commission standards, appropriate to medical and nursing specialty.
  • Identifies educational needs of individual or groups of clinical staff through daily contact; conducts informal education of staff, as appropriate; communicates learning needs to the appropriate Director and/or Clinical Educator.
  • Identifies and communicates clinical staff practice variances to the appropriate Director.
Dimensions of Patient Care Employee:
  • Identifies and corrects conditions that affect employee safety; upholds safety standards.
  • Maintains stable performance under pressure or opposition; handles stress in a manner that is acceptable to others and to the organization.
  • Makes customers and their needs a primary focus on one's actions; develops and sustains productive customer relationships.
  • Having achieved a satisfactory level of technical and professional knowledge in position related to areas, maintains current development and trends in area of expertise.
  • Clearly conveys information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
Qualifications/Specifications
  • Education: Graduate of an accredited program of nursing required: RN required; BSN preferred.
  • Licensure/Certification: Current state issued license required. Nurse may have license from a state within Nursing Compact.
  • Experience: Minimum of 2 years clinical experience in cardiovascular nursing preferred. Two years of case management experience preferred.

  • TotalMed Case Management Staffing | Travel Nurse RN

    4 days ago

    round rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in...

  • Case Manager RN

    2 days ago

    Little Rock, United States CVS Health Full time

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

  • Director of Hospital Case Management

    19 hours ago

    Little Rock, United States Midland-Marvel Consultants Full time

    Community healthcare facility looking to bring on Director Case Management! Responsible for the day to day operations and central focus on census management, patient care outcomes, and key care indicators, oversees the interdisciplinary plan of care and the discharge planning process to ensure the effectiveness and appropriateness of services. A patient and...

  • Travel Nurse RN

    2 days ago

    Round Rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas. Job Description & RequirementsSpecialty:Case Management Discipline:RN Start Date:12/30/2024 Duration:13 weeks 40 hours per week Shift:8 hours, days Employment Type:Travel We are seeking a Case Manager-Registered Nurse for an...

  • Travel Nurse RN

    2 days ago

    Round Rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas. Job Description & RequirementsSpecialty:Case Management Discipline:RN Start Date:ASAP Duration:13 weeks 40 hours per week Shift:8 hours, days Employment Type:Travel We are seeking a Case Manager-Registered Nurse for an assignment in...

  • Travel Nurse RN

    4 days ago

    Round Rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in...

  • Travel Nurse RN

    4 days ago

    Round Rock, United States TotalMed Case Management Staffing Remote Work Freelance Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in...

  • Travel Nurse RN

    1 day ago

    Round Rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in...

  • Travel Nurse RN

    5 days ago

    Round Rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in...

  • Travel Nurse RN

    11 hours ago

    Round Rock, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: 12/30/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment...

  • Case Manager II

    3 days ago

    Little Rock, United States Alliant Insurance Services Full time

    Case Manager IILittle Rock, AR, USA Req #2949Friday, December 13, 2024Alliant Insurance is hiring a Case Manager II for our acquisition, ASA group based in Little Rock, Arkansas. https://theasagroup.com/ SUMMARY Responsible to maintain primary ownership of annuity, life, long-term care and senior health cases which requires engaging in frequent...

  • Travel Nurse RN

    22 hours ago

    Round Rock, TX, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Round Rock, Texas. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: ASAP Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We are seeking a Case Manager-Registered Nurse...

  • Home Health Nurse

    4 days ago

    Little Rock, United States Care IV Home Health Full time

    Home Health Nurse (RN Case Manager)$5,000 SIGN-ON BONUS FOR FULL-TIME RN CASE MANAGERS Care IV Home Health is a locally owned and operated home health agency in Little Rock seeking a full-time RN Case Manager to join our esteemed team. As an RN Case Manager with Care IV, you will enjoy a professional and supportive environment that fosters flexibility,...

  • RN-Work Comp Case Manager!

    5 days ago

    Little Rock, United States Ideal Staffing Inc Full time

    Great Little Rock Company in search of a Registered Nurse for their Workers' Compensation Case Management team! Average 30-40 hours per week, Monday through Friday. Excellent Benefits including health, dental, and vision insurance with paid employee deductible and 401K! This is a great job for someone looking for less stress, a flexible schedule, and a...

  • Legal Case Manager

    1 day ago

    Little Rock, United States Apex Staffing Full time

    Premier personal injury firm hiring a Legal Case Manager to manage case files from opening to settlement! This person will be responsible for responding to inquiries from external customers, internal team members and attorneys as well as making calls and reviewing documentation for important information using the company's internal database. Job Duties: ...

  • Case Management Specialist II

    3 days ago

    Little Rock, Arkansas, United States Alliant Insurance Services Full time

    Job Summary:Alliant Insurance Services is hiring a Case Management Specialist II to support our operations team. As a key member of our team, you will be responsible for managing complex insurance cases, ensuring timely resolution, and providing exceptional customer service.About the Role:This is an excellent opportunity for a detail-oriented individual with...

  • Pre-Lit Case Manager

    3 days ago

    Little Rock, United States Rainwater Holt and Sexton Full time

    DescriptionRainwater, Holt & Sexton, PA is looking to hire a full-time Case Manager to join us at our personal injury law office in Little Rock, Arkansas Are you a forward-thinking team player who is determined to succeed? Would you like to work for a successful law firm that is not only known in our community as being trustworthy and hardworking but also...

  • RN Case Management Position

    3 days ago

    Round Rock, Texas, United States Genie Healthcare Full time

    RN Case Management Position OverviewGenie Healthcare is seeking an experienced RN to fill a 13-week travel assignment as a Case Manager. This position offers a unique opportunity to work in a fast-paced environment and make a meaningful impact on patient care.The ideal candidate will have strong clinical skills, excellent communication abilities, and a...

  • Pre-Lit Case Manager

    4 days ago

    Little Rock, United States Rainwater Holt and Sexton Full time

    DescriptionRainwater, Holt & Sexton, PA is looking to hire a full-time Case Manager to join us at our personal injury law office in Little Rock, Arkansas Are you a forward-thinking team player who is determined to succeed? Would you like to work for a successful law firm that is not only known in our community as being trustworthy and hardworking but also...

  • RN - Case Manager

    4 days ago

    Round Rock, United States Round Rock Medical Center Full time

    DetailsClient Name Round Rock Medical Center Job Type Travel Offering Nursing Profession RN Specialty Case Manager Job ID 29907869 Job Title RN - Case Manager Weekly Pay $1886.0 Shift DetailsShift 5 x 8 Hour Day Shift Scheduled Hours 40 Job Order DetailsStart Date 02/03/2025 End Date 05/05/2025 Duration 13 Week(s) Job Description Job Title:RN,CONTRACT - RN -...