HCA, Hospital Corporation of America Registered Nurse Case Management (Point of Entry) FT Mixed in Las Vegas, Nevada

The role of the Point of Entry RN Extender is responsible for the Medicare Order Form (MOF) at any Point ofEntry, with the appropriate patient status (Outpatient, Outpatient and begin Observation Services or Inpatient - On Medicare Addendum EInpatient Only List).The role reflects appropriate knowledge of CMS IPPS Final Rule – 2 Midnight Rule (effective 10/1/13).

This Point of Entry RN Extender will work in conjunction with the Point of Entry Case Managers, Physicians, TransferCenter Intake Coordinators, House Supervisors, NursingLeaders, Administrator on Call(AOC), Surgeons, and Emergency Room Physicians to facilitate the appropriate level of care and patient status. Thepositionemphasizesphysician satisfaction, and the ability to educate physicians as to the process of MOF authentication and theneed for medical necessity for inpatient admission of the acute hospital patient. The Point of Entry RN extender will be able to ascertain the appropriateCPT codes for proposed surgical procedures, and educatesurgeons, their office managers/coders, and Interventional Radiology staff. The role of the Emergency Department (ED) Point of Entry ( POE) Case Manager/Utilization Review Nurse is responsible for coordinating patient care services in the EmergencyDepartment as a pointof entry, as well as screening patientsfor medical necessity and appropriate level of care atthe time of the physician order to status in Outpatient, Outpatient with Observation Services or Inpatient. This role reflects appropriate knowledge of current state requirements, CMS Conditions of Participation and Regulatory Mandates, EMTALA, The Patient Bill of Rights, and/ or other Federal or State Regulatory Agency requirements specific to Utilization Review and Discharge Planning. Responsibilities includes facilating proactive patient admission service utilization in Interqual criteria in concert with any regulatory agency guidelines to ensure patients are appropriately placed in the correct patient status and level of care. This ED Point of Entry Case Manager/Utilization Review Nurse will work in conjunction with the ED and Admitting Physicians, and various health plans to facilitate the appropriate level of care. This position emphasizes patient/customer satisfaction, and balances individually identified patient/family needs with efficacious use of resources


  • Graduate of an accredited baccalaureate nursing program**


· · Minimum of five (5) years of clinical experience in nursing** · Minimum of five (5) years in acute hospital case management (1 year in critical care or ED) and in utilization review for Managed Care and Commercial payors. ** · Must have knowledge of CMS Rules and Regulations (including Patient Status and Level of Care).**


· Case Management Certification (or comparable) required. May attain certification within 6 months of start of this position). · Current license to practice as an RN in Nevada. Independently maintains license.**

Acquires required continuing education units to practice and maintain license

Title: Registered Nurse Case Management (Point of Entry) FT Mixed

Location: Nevada-Las Vegas-Southern Hills Hospital and Medical Center

Requisition ID: 08967-3617