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Registered Nurse RN Case Manager

Company: HCA.
Location: Richmond
Posted on: April 18, 2019

Job Description:

Standard

Qualifications:

Henrico Doctors' Hospital is a 340-bed community hospital offering a full range of healthcare services. We are a Level II Trauma facility, offering specialized vascular surgery, Neurosurgery, a comprehensive certified stroke center, orthopedics and groundbreaking diagnostic imaging. We're also a national trendsetter in kidney transplants through the Virginia Transplant Center and as part of the Virginia Institute of Robotic Surgery; we lead the state in minimally-invasive procedures with da Vinci robotic-assisted surgeries.

SPECIFIC ELEMENTS 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

Keywords: HCA., Richmond , Registered Nurse RN Case Manager, Executive , Richmond, Virginia

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