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Case Mgr UR Nurse - FT - Las Vegas

Company: Sunrise Hospital and Medical Center
Location: Las Vegas
Posted on: September 15, 2018

Job Description:

$7,500 Sign On Bonus with 2 years of experience Serving thecommunity for nearly 60 years, Employerprovides the most comprehensive, quality healthcare in SouthernNevada.As Las Vegas' largest acute care facility, Sunrise providessophisticated inpatient and outpatient services to the community.Sunrise Hospital & Medical Center has been recognized with thefollowing awards and accreditations: * Consumer Choice Awardrecipient for 15 consecutive years * Joint Commission Accredited *American Stroke Association's Get With The Guidelines (GWTG) GoldPlus Performance Achievement Award * CARF Accredited RehabilitationUnit * Nursing Professionals Top 100 Hospitals to Work For Join usas we achieve our Mission Statement: Sunrise Hospital & MedicalCenter and Sunrise Children's Hospital are dedicated to providingan unparalleled level of measurable quality in the delivery ofcost-effective, integrated healthcare services that are responsiveto the needs of our patients, physicians, employees, and community.Case Manager/Utilization Review Nurse - Full Time Days POSITIONSUMMARY: (Includes, but is not limited to): The RN CaseManager/Utilization Review Nurse is responsible for assessingdischarge-planning needs for the patients to coordinate thedelivery of healthcare services in conjunction with nursing,physicians, ancillary hospital departments, patients and families,and to identify and coordinate post-hospital needs of all patients,infant through geriatrics, in order to promote quality, continuityof care and safety for the patient.This position will facilitateto meet those needs, to facilitate timely and appropriatedischarges from the hospital, and to identify opportunities forimprovements in patient care.The RN Case Manager/UtilizationReview Nurse will facilitate Care Coordination through the IDT(Interdisciplinary Team) rounds.The RN Case Manager/UtilizationReview Nurse will act as a patient advocate, investigate alladverse occurrences, perform staff education related to utilizationof resources, discharge planning, and psychosocial aspects ofhealthcare delivery.In addition, the RN Case Manager/UtilizationReview Nurse must provide documentation of all functions asrequired by regulatory agencies.He/she will monitor utilization ofresources, track any avoidable days identified, provide clinicalreviews in a timely manner utilizing InterQual criteria, and followreview protocols for the department.The RN CaseManager/Utilization Review Nurse would determine the medicalnecessity for all admissions and need for continued stay, as wellas be able to status the patient in the correct level of care -Observation VS.Admission.MINIMUM QUALIFICATIONS: * Must have awide range of medical knowledge with various types of patientcare/services performed in an acute hospital setting.* Must havestrong PC skills with current operating systems.* Must haveknowledge of Interqual criteria.* Must have critical thinkingskills and the ability to obtain and summarize medical informationutilizing various reports and computer systems.* Must haveknowledge of accreditation standards and compliance requirements,as well as government and non-government payor practices,regulations, standards and reimbursement.* Must have priorinsurance review experience.* Must be able to retain a high levelof confidentiality.* Works independently and is flexible with alljob duties.* Must have outstanding telephonic and personableskills to communicate with various entities, (i.e.physicians,health plans, review nurses, clerical personnel, etc.).* Maintainsprofessional credentialing and continuing education pertaining tojob description.EDUCATION: * Graduate of an accredited nursingprogram - diploma, associate degree, or baccalaureate program; BSNpreferred.EXPERIENCE: * Minimum of three (3) years of clinicalexperience in nursing; Minimum of one (1) years in acute hospitalcase management and utilization review for Medicare, Managed Careand Commercial payors.* Must have knowledge of Interqual.Musthave demonstrated prior job interactivity with multipledepartments, disciplines and physicians, as well as organizationallevels.* Must have knowledge of DRGs and GMLOS.KNOWLEDGE, SKILLS,AND ABILITIES: * Must demonstrate excellent interpersonal, writtenand verbal skills.* Be well organized and have the ability toprioritize and handle multiple tasks efficiently and independently.* Have demonstrated ability to initiate and follow through withmultiple projects.* Must be a self-starter and independent workerwith excellent time management skills.* Be able to thrive in afast-paced, friendly and process-oriented office environment.*Must possess strong PC skills with current operating systems andhave strong InterQual criteria knowledge.* Must be able to pass ayearly InterQual criteria exam.* CERTIFICATION: Case ManagementCertification (or comparable) required.May attain certificationwithin 6 months of start of this position)* LICENSURE: * Currentlicense to practice as an RN in Nevada.Independently maintainslicense.Acquires required continuing education units to practiceand maintain license.

Keywords: Sunrise Hospital and Medical Center, Las Vegas, Case Mgr UR Nurse - FT - Las Vegas, Healthcare, Las Vegas, Nevada

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