Job Description

RN Case Manager/Utilization Review Manager Northern Cochise Community Hospital
Job CategoryNursing
ScheduleFull time
Shift1 - Day Shift

 

Northern Cochise Community Hospital, Inc.

 

Case Manager / Utilization Review Manager Position open!

 

Northern Cochise Community Hospital, Inc., located in Willcox, AZ, is seeking a compassionate and knowledgeable Case Manager/Utilization Review Manager to join our team in providing quality care. NCCH provides health services as a 24-bed Critical Access Hospital with ancillary services, over 20 visiting specialists, a 6 bed Level IV Trauma ER, and two off-site Rural Health Clinics.

 

Essential Functions: 

The Case Manager/Utilization Review Manager will be responsible the oversight of Case Management & Utilization Review for NCCH. Coordinates health care and other related services for Acute, Observation, Skilled, Swing, and ER patients through multidisciplinary care team and physicians. Manages patient care stays according to Milliman criteria. Assist with admission and discharge planning. Conducts review of patient services utilized or to be utilized.  RN designated to coordinate social services.

Manages hospital stay for patients through coordination of care.

  • Coordinates patient care with physicians, nursing staff and other health care professionals to facilitate patient outcomes. Provides education for providers and patients regarding services available through NCCH.
  • Facilitates admission and discharge planning activities for patients.  Assists in the Emergency Department with discharge planning and coordinating community services.
  • Tracks when claims have been denied based on ‘medical necessity’ and writes appeal letters to insurance carriers. Provides appeal letters for denials based on medical necessity and authorizations.
  • Monitors care plans of current patients. Reviews level of care assignment is reflective of the physician admission order.
  • Responsible for MOON compliance in accordance with CMS regulations. Responsible for the compliance with important message from Medicare on Patient Rights and the Detail Notice of Discharge in accordance with CMS regulations.

Evaluates patient charts to ensure that treatment and length of stay are appropriate & cost-effective.

  • Provides ongoing objective evaluation of the important aspects of patient care through daily review of patient charts and identification of variations in care to provide data for use in the correction of potential problems and to meet the requirements of all regulatory agencies.
  • Performs concurrent chart reviews to ensure necessary documentation is provided.

RN designated to coordinate social services for swing-bed patients.

 

Education and/or Experience:

Associate Degree in Nursing required.  Bachelor of Science in Nursing (BSN) preferred.  Minimum five years experience as registered nurse in a rural facility in areas of Med/Surg, SNF and/or ER required.  3 years of Case Management experience required.

 

Certificates, Licenses, Registrations:

  • Current, unrestricted, Arizona Registered Nurse License

  • Current Basic Life Support (BLS)

    Necessary Knowledge, Skills, and Abilities:

  • Knowledge of  criteria for approved medical coverage and reimbursements for medical care provided.& ability to work with various insurance carriers, Medicare, AHCCCS, and other third party payors during case management process to obtaining approval for patient stays and/or extension of patient stays by providing proof of medical necessity, etc.
  • Knowledge of Milliman guidelines and how to apply them to patient admissions and/or ongoing patient stays.

 


Applications can be submitted online at or at 901 W. Rex Allen Dr. Willcox AZ 85643.

 

Please contact Rebekah Noble, Recruitment & Retention Specialist, at or at 520-766-6435 for more information!

 

 

Equal Opportunity Employer Provider (EOEP).

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Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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