Case Mgr 9/13/2016

HCA Healthcare Richmond, VA

Company
HCA Healthcare
Job Classification
Full Time
Company Ref #
00448-34539
AJE Ref #
576162680
Location
Richmond, VA
Experience
Mid-Career (2 - 15 years)
Job Type
Regular

JOB DESCRIPTION

APPLY
Job Code: 00448-34539

Full-time

No Weekends

SPECIFIC E

LEMENTS AND ESSENTIAL FUNCTIONS*

* Applies the rules of Severity of Illness, Intensity of Service, and Discharge Screens/Indicators consistently in evaluating medical necessity.

* Performs admission and concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan.

* Educates patients and families to the patient s needs post discharge and informs them of the alternatives available to meet those needs.

* Refers patients who require extended care post discharge to long term care facilities. Once an appropriate bed is located, arranges for the patient s transfer

* Collaborates with community agencies to provide services to assist with housing, financial, transportation, psychosocial, educational, home health, and home medical equipment needs of patients/families post discharge.

* Initiates patient/family conference with the health care team to achieve positive outcomes.

* Identifies, tracks, and records Alternative Care Days (ACDs). Intervenes to prevent or decrease ACDs as appropriate.

* Initiates denial and appeal process in accordance with policy. Refers HINN letters to Director.

* Maintains knowledge base for identification and reporting of potential patients with contractual adjustment needs and length of stay issues.

* Provides crisis and supportive counseling to enhance the patient s and family s problem solving and coping skills. Counsels patient/families regarding advance medical directives.

* Takes a proactive role in discharge planning.

* Maintains knowledge base with an awareness of current trends that influence health care practice

EXPERIENCE

* Required: Five + years of recent clinical experience as RN.

* Preferred: Commercial Utilization Management and/or Case Management experience; Quality Management Experience.

EDUCATION

* Required: Registered Nurse with current Virginia licensure.

* Preferred: B.S.N.

Last Edited: 08/11/2016