Registered Nurse Case Manager /UR- Pediatrics - Case Management - Full Time - Days
Location: Las Vegas Nevada
Description: Sunrise Hospital and Medical Center is looking of Registered Nurse Case Manager /UR- Pediatrics - Case Management - Full Time - Days right now, this job will be placed in Nevada. Detailed specification about this job opportunity please give attention to these descriptions. The Pediatric RN Case Manager/Utilization Review Nurse is responsible for assessing discharge-planning needs for the pediatric patients to coordinate the delivery of healthcare services in conjunction with nursing, physicians, ancillary hospital departments, patients and families, and to identify and coordinate poste-hospital needs of pediatric patie nts in order to promote quality! , continuity of care and safety for the pediatric patient. Thi! s position will facilitate to meet those needs, to facilitate timely and appropriate discharges from the hospital, and to identify opportunities for improvements in patient care. The Pediatic RN Case Manager/Utilization Review Nurse will facilitate Care Coordination through the IDT (Interdisciplinary Team) rounds. The Pediatric RN Case Manager/Utilization Review Nurse will act as a patient advocate, investigate all adverse occurrences, perform staff education related to utilization of resources, discharge planning, and psychosocial aspects of healthcare delivery. In addition, the Pediatric RN Case Manager/Utilization Review Nurse must provide documentation of all fuctions as required by regulatory agencies. He/she will monitor utilization of resources, track any avoidable days identifed, provide clinical reviews in a timely manner utilizing InterQual criteria, and follow review protocols for the department. The Pediatric RN Case Manager/Utilization Review Nurse would determ! ine the medical necessity for all admissions and need for continued stay, as well as be able to status the patient in the correct status - Outpatient in a Bed, Observation VS. In-patient Admission.
Qualifications
Minimum Qualifications:
Must have a wide range of medical knowledge with various types of patient care/services (especially in the Pediatric area) performed in an acute hospital setting.
Must have strong PC skills with current operating systems.
Must have knowledge of Interqual criteria.
Must have critical thinking skills and the ability to obtain and summarize medical information utilizing various reports and computer systems.
Must have knowledge of accreditaion standars and compliance requirements, as well as government and non-government payor practices, regulations, standards and reimbursement.
Must have prior insurance review experience.
Must be able to retain a high level of co! nfidentiality.
Works independently and is flexible with all jo! b duties..
Must have outstanding telephonic and personable skills to communicate with vaious entities, (i.e. physicians, helath plans, review nurses, clerical personnel, etc.)
Maintains professional credentialing and continuing education pertaining to job description.
Education:
Graduate of an accredited nursign program - diploma, associate degree, or bacculaureate program; BSN preferred.
Experience:
Minimum of five (5) years of clinical experience in nursing; Minimum of seven (7) years in acute Pediatric hospital case management and utilization review for Medicare, Managed Care and Commercial payors. Must have knowledge of Interqual. Must have demonstrated prior job interactivity with multiple departments, disciplines and physicians, as well as organizational levels. Must have knowledge of DRGs and GMLOS.
Certification:
Case Management Certification (CCM) or CPUR (Certified Professional Utilizati! on Review) preferred.
Licensure:
Current license to practice as an RN in the State of Nevada. Independently maintains license. Maintains required continuing education units to practice and maintain license.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Sunrise Hospital and Medical Center.
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This job starts available on: Wed, 11 Dec 2013 07:03:17 GMT
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