Clinical Review Nurse Care Manager
Clinical Review Nurse Care Manager
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1 Vacancy
Job Description
Thanks for your interest in Childrens Mercy!
Do you envision finding a meaningful role with an inclusive and compassionate team At Childrens Mercy we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference which is why we have been recognized by U.S. News & World Report as a top pediatric hospital for eleven consecutive years.
Childrens Mercy is in the heart of Kansas City a metro abounding in cultural experiences vibrant communities and thriving businesses. This is where our patients and families live work and play. This is a community that has embraced our hospital and we strive to say thanks by giving back. As a leader in childrens health we engage in meaningful programs and partnerships throughout the region so that we can improve the lives of children beyond the walls of our hospital.
Overview
The Clinical Review Nurse Care Manager utilizes clinical expertise evidence-based guidelines insurance knowledge business acumen and high level of communication skills to ensure appropriate utilization of and reimbursement for resources from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued stay payer authorization per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works with physicians and multidisciplinary teams to evaluate the medical plan length of stay avoidable days/delays and progression of care. Works collaboratively with Revenue Cycle to ensure authorizations and denials are addressed timely for clean claims submission. This position will participate in ongoing professional development activities quality improvement and continuing education activities. This role Improves efficiency and reduces health care costs as evidenced by decreased lengths of stay decreased re-admissions decreased denials and increased patient satisfaction.
At Childrens Mercy we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve as well as our core values of kindness curiosity inclusion team and integrity.
Additionally its important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve as well as the Childrens Mercy staff we want to let you know that the seasonal influenza vaccine is a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles mumps rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus diphtheria acellular pertussis (Tdap) vaccination since 2005. If you are selected for this position you will be asked to supply your immunization records as proof of vaccination. If you and have any concerns about receiving these vaccines medical and/or religious exemptions can be further discussed with Human Resources.
Responsibilities
- Evaluate appropriateness of each admission using evidence-based clinical guidelines to ensure correct bed status.
- Ensures medical appropriateness of care by facilitating timely and proper patient throughput progression; securing continued stay authorizations; continually reassessing medical necessity; and partnering with the multidisciplinary team.
- Mitigates and manages denials for patient status and continued patient stays with Attending Physician Physician Advisor Inpatient Nurse Care Manager and insurance/payer.
- Collaborates with Revenue Cycle to improve financial processes and outcomes.
- Participate in ongoing professional development activities making a meaningful contribution to quality improvement and continuing education of self and others.
Qualifications
- Bachelors Degree BSN and
- 3-5 years experience
- Experience as a care manager or demonstrated leadership skills in a previous role
- 3-5 years experience
- One of the following: Licensed RN - MO Registered Nurse Multistate License Missouri required upon hire
- One of the following: Licensed RN - Kansas Registered Nurse Multistate License Kansas required upon hire
- One of the following: Licensed RN - RN Compact license for all states besides KS and MO
- Must Obtain KS or MO compact within 60 days of hire
- One of the following: American Case Management Certification or Certified Case Manager
- Employees must obtain CCM within 3 years of hire
- Employees must obtain ACM within 3 years of hire
- Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications Required Upon Hire
- CPN Certification Preferred
Benefits at Childrens Mercy
The benefits plans at Childrens Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families.
Learn more about Childrens Mercy benefits.
Starting Pay
Our pay ranges are market competitive. The pay range for this job begins at $35.00/hr but your offer will be determined based on your education and experience.
Remote Work/Work from Home
This position is not eligible to work remotely which means that the person hired will be required to work onsite at one of our Childrens Mercy locations and may not work from home.
EEO Employer/Disabled/Vet
Childrens Mercy hires individuals based on their job skills expertise and ability to maintain professional relationships with fellow employees patients parents and visitors. A personal interview formal education and training previous work experience references and a criminal background investigation all are factors used to select the best candidates. The hospital does not discriminate against prospective or current employees based on the race color religion sex national origin age disability creed genetic information sexual orientation gender identity or expression ancestry or veteran status. A drug screen will be performed upon hire. Childrens Mercy is smoke and tobacco free.
Our commitment to Diversity & Inclusion
CM is committed to creating a diverse and inclusive workforce. Our patients and families come from all walks of life and so do we. We know that our greatest strengths come from the people who make up our team so we hire great people from a wide variety of backgrounds not just because its the right thing to do but because it makes our hospital stronger and our patient care more compassionate.
If you share our values and our enthusiasm for service you will find a home at CM. In recruiting for our team we welcome the unique contributions that you can bring including education ideas culture ethnicity race sex sexual orientation gender identity and expression national origin age languages spoken veteran status color religion disability and beliefs.
Required Experience:
Manager
Employment Type
Unclear
