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RN Case Manager

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POST DATE 9/13/2016
END DATE 2/5/2017

HCA Healthcare Richmond, VA

Richmond, VA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)


Job Code: 00035-34587


Days (rotating weekends)

1. Review health records for appropriateness of application of 2 Midnight Rule for initial review of all Medicare admissions. Perform continued stay reviews of trauma patients for appropriateness based on InterQual criteria.

2. *Performs admission and concurrent reviews for all payors and maintains legible documentation as directed by the Utilization Management Plan.

3. *Review of patient notes identifying and addressing any conflict in medical orders or lack of management plan.

4. *Build a rapport by providing continuity of care with patients and acting as their advocate throughout their hospital stay.

5. *Collaborate between multiple care givers and foster communication between medical teams and nursing staff

6. *Identifies and intervenes to coordinate care of trauma patients in relation to appropriateness of level of care, length of stay and resource utilization issues.

7. *Identifying barriers to discharge and contacting relevant personnel to overcome these.

8. *Initiates and monitors referral process of patients post discharge.

9. *Identifies, tracks, and records Avoidable Days [AD], intervening to prevent or decrease as appropriate.

10. *Initiates denial and appeal process in accordance with policy.

11. *Demonstrates awareness of current trends that influence health care practice and assures compliance with professional, regulatory, governmental and organization standards.


Required: Five + years of recent clinical experience.

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


Required: Registered Nurse

Preferred: B.S.N.

Last Edited: 08/09/2016