RN Case Manager

HCA Healthcare•Las Vegas, NV

About The Position

The RN Case Manager promotes patient-centered care by coordinating each patient’s plan of care during their stay, managing length of stay, ensuring appropriate resource use, and developing a safe discharge plan with the multidisciplinary team. The role reviews admissions for appropriateness and medical necessity, provides admission and concurrent reviews to payors, and maintains monitoring systems to ensure reviews are completed on time. The case manager makes referrals related to medical necessity, utilization, quality, or risk management, and coordinates ongoing care and utilization with hospital staff, physicians, ancillary services, and patients. The role also plans, coordinates, and facilitates discharge needs, including home health, durable medical equipment, placement, community resources, and hospice care.

Requirements

Graduate of an accredited School of Nursing program.
Current Registered Nurse licensure in the state of Nevada.
Current Basic Cardiac Life Support (BLS) certification.
Knowledge of CMS rules and regulations, including Patient Status and Level of Care.
Ability to maintain accurate and specific documentation as directed by the Case Management Plan.
Knowledge of DRGs and GMLOS.

Nice To Haves

Two years of hospital case management experience and three years of nursing experience are preferred.
A minimum of five years of clinical nursing experience with two years of critical care or nursing leadership experience may be considered in lieu of case management experience.

Responsibilities

Coordinate the patient’s plan of care with the multidisciplinary team and promote patient-centered care.
Manage length of stay and ensure appropriate resource management.
Develop safe and appropriate discharge plans in collaboration with the multidisciplinary team.
Review admissions for appropriateness and medical necessity based on approved criteria and standards.
Provide payors with admission and concurrent reviews as requested.
Maintain a system for monitoring admissions and ensure timely concurrent reviews.
Make appropriate referrals related to medical necessity, utilization, quality, or risk management.
Coordinate ongoing care and utilization with hospital staff, physicians, ancillary services, and patients.
Plan, coordinate, and facilitate discharge needs, including home health, durable medical equipment, placement, community resources, and hospice care.
Maintain accurate and specific documentation as directed by the Case Management Plan.
Interpret clinical data from hospital medical records for admission and concurrent reviews for Medicare and self-pay patients.
Identify potential utilization and quality management issues and report them to appropriate departments or personnel.

Benefits

Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine benefits.
Wellbeing support, including free counseling and referral services.
Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
Employee Stock Purchase Plan and flexible spending accounts.
Preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
Fertility and family-building benefits and adoption assistance.
Life insurance and supplemental health protection plans.
Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.