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Registered Nurse Case Manager
2 months ago
The Registered Nurse Case Manager will play a vital role in promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe and appropriate discharge plan in collaboration with the multidisciplinary team.
Responsibilities- Perform admission review to determine appropriateness and medical necessity based on approved criteria and standards
- Provide payors with admission and concurrent reviews as requested
- Maintain a system for monitoring all admissions and ensure timely concurrent reviews
- Make appropriate referrals related to medical necessity, utilization, quality, or risk management and coordinate ongoing care and utilization with hospital staff, physicians, ancillary services, and patients
- Plan, coordinate, and facilitate all discharge needs for patients, including Home Health, DME, placement, community resources, and hospice care
- Graduate of an accredited School of Nursing program
- Current licensure as a Registered Nurse in the state of Nevada
- Current Basic Cardiac Life Support (BLS)
- Two years in hospital case management with three years nursing experience preferred
- Will consider a minimum of five years of clinical nursing experience with two years critical care or nursing leadership experience in lieu of case management experience
- Must have knowledge of CMS Rules and Regulations (including Patient Status and Level of Care)
- Can maintain accurate and specific documentation directed by the Case Management Plan
- Interprets clinical data compiled by hospital medical records for the purpose of admission/concurrent review for Medicare and self-pay patients
- Identifies potential utilization and quality management issues, reporting all issues to the appropriate department or personnel
- Knowledge of DRGs and GMLOS
Sunrise Hospital & Medical Center provides Las Vegas and the Southwest region with high-quality, advanced healthcare services. We have been serving our community for nearly 60 years. Sunrise Hospital has been a Consumer Choice Award recipient for 15 consecutive years. We are the largest acute care facility in Nevada and the state's only fresh post-op Pediatric CICU. Our facility offers an advanced comprehensive stroke center which received the Gold Plus Performance Achievement Award from the GWTG.
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.
