Registered Case Manager - Emergency Services/Point of Entry - Full Time Nights
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POST DATE 9/13/2016
END DATE 10/29/2016
Las Vegas, NV
JOB DESCRIPTIONJob Code: 01541-12598
Nights (rotating weekends)
The role of the Emergency Department (ED) Point of Entry ( POE) Case Manager/Utilization Review Nurse is responsible for coordinating patient care services in the Emergency Department as a point of entry, as well as screening patients for medical necessity and appropriate level of care at the time of the physician order to status in Outpatient, Outpatient with Observation Services or Inpatient. This role reflects appropriate knowledge of current state requirements, CMS Conditions of Participation and Regulatory Mandates, EMTALA, The Patient Bill of Rights, and/ or other Federal or State Regulatory Agency requirements specific to Utilization Review and Discharge Planning. Responsibilities includes facilitating proactive patient admission services utilizing Interqual criteria in concert with any regulatory agency guidelines to ensure patients are appropriately placed in the correct patient status and level of care. This ED Point of Entry Case Manager/Utilization Review Nurse will work in conjunction with the ED and Admitting Physicians, and various health plans to facilitate the appropriate level of care. This position emphasizes patient/customer satisfaction, and balances individually identified patient/family needs with efficacious use of resources.
EDUCATION: Graduate of an accredited nursing program diploma, associate degree, or baccalaureate program; BSN preferred.
EXPERIENCE: Minimum of five (5) years of clinical experience in nursing; Minimum of five (5) years in acute hospital case management ( 1 year in critical care or ED) and in utilization review for Managed Care and Commercial payors. Must have knowledge of CMS Rules and Regulations (including Patient Status and Level of Care).
CERTIFICATION: Case Management Certification (or comparable) required. May attain certification within 6 months of start of this position).
LICENSURE: Current license to practice as an RN in Nevada. Independently maintains license. Acquires required continuing education units to practice and maintain license.
Associate's Degree/College Diploma
Last Edited: 06/14/2016