Nurse Care Manager
7 days ago
Job Summary
We are seeking a skilled Nurse Care Manager to join our team at Medstar. As a key member of our healthcare team, you will play a critical role in ensuring high-quality patient care and efficient hospital operations.
About the Role
The successful candidate will conduct comprehensive case reviews to determine appropriate admit status and level of care, collaborating with medical staff and ancillary hospital disciplines to ensure seamless patient care delivery.
Responsibilities
- Conduct admission, concurrent, and retrospective case reviews to meet hospital objectives of high-quality patient care in the most efficient way
- Work closely with medical staff, physician advisors, social workers, and other hospital departments to meet patients' healthcare needs in a cost-effective manner
- Perform thorough medical record reviews, documenting pertinent information and communicating with third-party payors to ensure timely reimbursement and minimize unnecessary denials
- Implement strategies to prevent potential denials by effectively communicating with attending physicians and other stakeholders
- Develop and implement non-coverage, ABN, MOON letters, and other necessary documents as per organizational, governmental, and accrediting organization policies
- Participate actively in IDR, Length of Stay, and other meetings as per hospital policies
- Identify potential risks related to patient care and communicate with relevant hospital departments, including risk management, quality, safety, and infection control
- Serve as a resource to the healthcare team by providing education through in-services, staff meetings, and formal educational settings on utilization management
- Maintain current knowledge of State and Federal regulatory requirements related to the utilization review process
- Identify dynamics of neglect/abuse and report to the appropriate in-house departments and governmental agencies
Requirements
To be successful in this role, you will need:
- An Associate's degree in Nursing; Bachelor's degree in Nursing preferred
- A minimum of 3-4 years of experience in an acute care setting, with 2 years of experience in case management, insurance, utilization review, or a related field preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia or the State of Maryland depending on work location
- CCM - Certified Case Manager certification is preferred
Salary Range
The estimated salary range for this position is $87,318 - $157,289, based on factors such as location and experience.
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