REGISTERED NURSE MANAGER - CASE MANAGEMENT - Next GenHealth Staffing

JOB RESPONSIBILITIES-

Registered Nurse Manager - Case Management

RN MGR - NCM

Full-Time

Registered Nurse Manager candidates for the Case Management department will have the following job responsibilities:

• You will communicate proactively and cooperatively with Patient Access, Patient Account Services (PAS) and Central Verification Office (CVO) personnel to ensure proper pre-certification and consistency of admissions status designation between physician order and EMR.
• You will communicate known changes to patient payer information and other relevant financial characteristics of coverage to appropriate admissions and billing personnel.
• You will proactively ensure that required clinical justification is provided to third-party payers to obtain recertification for continued hospitalization and treatment and that transfer of this information, together with days approved and contact information is provided timely to the PAS and CVO via computerized insurance review documentation.
• You will serve as a liaison between third-party payers, patient access PAS, and CVO to ensure communication of all pertinent information regarding level of care, billing and reimbursement.
• You will work with the patient and family to identify alternate financial resources available to meet the cost of necessary post-discharge needs or to recommend alternate care options when necessary funding is unavailable.
• You will proactively initiate an expedited appeals process with payers and communicates with denials management regarding anticipated or verified denials and cooperates with denials management to provide additional clinical information for appeals.
• You will educate patient and family on case manager role and process for contacting the case manager for questions.

JOB QUALIFICATIONS-

Registered Nurse Manager - Case Management

RN MGR - NCM

Full-Time

Registered Nurse Manager candidates for the Case Management department must meet the following minimum job qualifications:

• RN licensure in the state of TX or Compact State.
• Associates Degree or BSN completion within 3 years of hire date
• Must have Case Management experience within the acute care setting min 2 years

Compensation: $99,049.60 max