Thanks for your interest in Children's Mercy!Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s 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.Children’s 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 children’s 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.OverviewThe 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 Children’s 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, it’s 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 Children’s 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

Bachelor's Degree BSN and

3-5 years experience

Experience as a care manager or demonstrated leadership skills in a previous role
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 Children's MercyThe benefits plans at Children’s 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.Starting PayOur 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 HomeThis position is not eligible to work remotely, which means that the person hired will be required to work onsite at one of our Children's Mercy locations and may not work from home.EEO Employer/Disabled/VetChildren’s 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. Children’s Mercy is smoke and tobacco free.Our commitment to Diversity & InclusionCM 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 it’s 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.

Clinical Review Nurse Care Manager

About Job

Similar Jobs