Case Mgr Point of Entry
Location:
Las Vegas , Nevada
Posted:
October 20, 2017
Reference:
02270-8264
MountainView Hospital is a state-of-the-art, full-service medical facility located in the heart of Northwest Las Vegas, one of the fastest growing areas in the valley. With a staff of more than 1,440 dedicated and talented employees, as well as more than 1,200 outstanding physicians at our 340-bed facility, MountainView Hospital is recognized for high patient satisfaction and for providing quality and compassionate care to our community since 1996.

Join us as we achieve our Mission Statement:

MountainView Hospital is committed to the care and improvement of human life. In recognition of this commitment, we strive to deliver high quality, cost effective health care in the community we serve.
Job Description:
The role of the Point of Entry RN Extender is responsible for the Medicare Order Form (MOF) at any Point of Entry, with the appropriate patient status (Outpatient, Outpatient and begin Observation Services or Inpatient - On Medicare Addendum E Inpatient Only List).The role reflects appropriate knowledge of CMS IPPS Final Rule - 2 Midnight Rule (effective 10/1/13).

This Point of Entry RN Extender will work in conjunction with the Point of Entry Case Managers, Physicians, Transfer Center Intake Coordinators, House Supervisors, Nursing Leaders, Administrator on Call (AOC), Surgeons, and Emergency Room Physicians to facilitate the appropriate level of care and patient status.

  • The position emphasizes physician satisfaction, and the ability to educate physicians as to the process of MOF authentication and the need for medical necessity for inpatient admission of the acute hospital patient.
  • The Point of Entry RN extender will be able to ascertain the appropriate CPT codes for proposed surgical procedures, and educate surgeons, their office managers/coders, and Interventional Radiology staff.
  • 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

Qualifications:
EDUCATION:

  • Graduate of an accredited baccalaureate nursing program

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).

CERTIFICATE/LICENSE:
• Case Management Certification (or comparable) required. May attain certification within 6 months of start of this position).
• Current license to practice as an RN in Nevada. Independently maintains license.

A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom

Know someone who would be interested in this job? Share it with your network.