Top 19 Nurse case manager Jobs in Warrensburg, Mo

Utilization Review RN
Western Missouri Medical Center —Warrensburg, MO
- Full-time
- RN License
- HIPAA
- Mid-level
Quick Apply
1d
Hospice LPN
Three Rivers Hospice —Warrensburg, MO
- $65,000 - $68,000 a year
- Full-time
- Skilled nursing facility
- Nursing home
- Mid-level
- Paid holidays
- Disability insurance
Inpatient Therapist Lead
Compass Health Network —Windsor, MO
- $37.49 - $40.49 an hour
- Full-time
- Acute care
- LMFT
- Doctoral degree
- Wellness program
- Paid holidays
Quick Apply
Case Manager - RN
Hines & Associates Inc —United States
- $60,000 - $66,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Paid holidays
- Disability insurance
Quick Apply
Travel ICU RN Job in Birmingham, Alabama
Gifted Healthcare —United States
- $2,071.19 - $2,591.84 a week
- Overtime
- Nursing
- Anatomy knowledge
- Medication administration
- Health insurance
- Dental insurance
Quick Apply

Related jobs to explore

Based on your search for nurse case manager

Residential Case Manager
House of Compassion —Grandview, MO
21 years of age or older, with a valid driver's license and acceptable driving record. Bachelor's degree in social work, psychology, counseling, human services,…
$22 - $25 an hour
Quick Apply
3h
Associate/Social Services Specialist (I/II/III)
State of Missouri —Missouri
Bring your resume, transcripts (if applicable), 3 references, and a valid driver's license. ⚠️ A valid vehicle operator’s license is required.
$44,630.40 - $51,602.16 a year
5d

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Home Health RN Case Manager
Ohio Living —Westerville, OH
Must possess a valid driver's license and acceptable driving record. Current unencumbered license for the state of Ohio to practice as a Registered Nurse (RN)…
Quick Apply
Hospice Registered Nurse Case Manager (RN)
Suncrest Hospice —Columbus, OH
Must be willing to drive with reliable transportation, valid driver’s license, and auto insurance, to be able to travel across the service area.
$82,000 - $93,000 a year

Show more jobs in cities nearby

I want to receive the latest job alert for nurse case manager in warrensburg, mo

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

nurse case manager jobs near warrensburg, mo

Licensed Practical Nurse jobs in Warrensburg, MO

Public Health Nurse jobs in Macomb County, MI

Licensed Practical Nurse jobs in Bend, OR

Licensed Practical Nurse jobs in Phoenix, AZ

Travel Nurse jobs in Nebraska

Licensed Practical Nurse jobs in Biloxi, MS

Licensed Practical Nurse jobs in Killeen, TX

Licensed Associate Professional Counselor jobs in Atlanta, GA

Nurse 1099 jobs in Atlanta, GA

Utilization Review Nurse jobs in Fort Worth, TX

Student Nurse jobs in Detroit, MI

Rn Clinical Review Nurse jobs in Remote

Utilization Review Nurse jobs in Santa Clara, CA

Utilization Review Nurse jobs in Hartford, CT

Remote Nurse jobs in Portland, ME

Massage Therapist jobs in Oklahoma City, OK

Massage Therapist jobs in Santa Rosa, CA

Prn Respiratory Therapist jobs in Fort Worth, TX

Physical Therapist Assistant jobs in North Carolina

Music Therapist jobs in California

Utilization Review RN

Western Missouri Medical Center -
Warrensburg, MO

Quick Apply

Job Details

Full-time
1 day ago

Qualifications

Direct patient care
RN License
Team leadership
High school diploma or GED
Task prioritization
Computer skills
Hospital experience
Team building

Full Job Description

Description:

PURPOSE STATEMENT

Responsible for review of all inpatient and outpatient admissions to the hospital for appropriateness and manages all access points for admission to the hospital including but not limited to Emergency Department admissions, direct admissions, transfers into and out of the ED, other facilities, and admissions from outpatient areas. Evaluates the medical necessity, appropriateness, and efficient use of health care services of all hospitalizations, inpatients or outpatients. Skilled with the application of InterQual and MCG criteria, works collaboratively with the physicians, healthcare team and the care coordinator to optimally certify the level of care and facilitates the patient’s movement through the continuum of care as appropriate.

ESSENTIAL FUNCTIONS

Monitor use of healthcare resources, collaborate with physicians to ensure patient receives diagnostics/evaluations in the proper setting (i.e. inpatient vs. outpatient).
Maintain current knowledge of Condition Code 44, Hospital CoP’s and CMS (Medicare) rules and regulations.
Serve as an expert resource to physicians, healthcare staff in the application of InterQual and MCG, and use of evidence-based practices.
Serve as patient advocate and enhance a collaborative relationship between the physician and multidisciplinary team with the patient and family to maximize informed decisions.
Communicate effectively with third party payors regarding certification, completes initial review prior to or at time of admission.
Maintain knowledge of InterQual and MCG medical necessity criteria and apply appropriately.
Identify the need to clarify documentation through quality audits in records and initiate communication with physicians utilizing appropriate ‘query’ tools in order to capture documentation in the medical record to accurately support the patient’s severity of illness.
Demonstrate knowledge of documentation requirements and guidelines.
Assist in the improvement of overall quality and completeness of clinical documentation by ensuring that documentation clarification with physicians has been recorded in the patient’s chart.
Review clinical data for ED admits, make level of care recommendations to the ED physician, and obtain any additional clinical information to assist in the level of care determination.
Manage all direct admits, clarify level of care orders and perform InterQual screening as appropriate. Acquires additional information if necessary to assist in the level of care determination.
Review all requests for changes in status for admission from the PACU or any outpatient areas. Apply InterQual and MCG criteria to determine appropriateness for the level of care requested and consult with Attending if necessary.
Ensure the operative procedure performed is the operative procedure prior-authorized with the third-party payor and communicate any variance.
Serve as a resource for facilitating patient transfers, including but not limited to, obtaining or providing clinical information from/to the referring/accepting facility. Perform clinical reviews of all inbound transfers for appropriateness.
Demonstrate a working knowledge of HIPAA guidelines and utilize them in all aspects of communication with customers.
Cooperate/communicate with the QIO when a Medicare patient has appealed for their discharge.
Consult the Physician Advisement process to resolve issues and refer appropriate cases per established protocol.
Adhere to and implement the Utilization Management Plan per CMS Conditions of Participation.
Report and document adverse events and reportable conditions.
Consistently follows departmental procedures regarding level of care (service) changes.
Discuss cases with particular issues relating to utilization appropriateness with Manager/Director and notify appropriate peoples when indicated.
Display a high level of flexibility, adaptability, and organizational skills in response to the workload and effectively prioritize work while maintaining productivity.
Assist with collection of data for case management metrics per the UM Plan.
Support the Medical Center quality improvement process by identifying and appropriately communicating potential quality issues and participating in focused quality monitoring (i.e. concurrent notification of ADRS, sentinel events, etc.).
Contribute to the development of competencies related to job functions and participate in competency evaluations.
Participate in department-based Performance Improvement activities.
Review patient’s medical record for over, under and inappropriate utilization. Reviews for justification of patient admission and continued stay. Conduct timely and accurate interventions and follow-through.
Inform Patient Financial Services of patients in need of financial counseling.
Track and document avoidable days and readmissions with proactive, concurrent action taken when indicated.
Maintain regular and predictable attendance.
Perform other essential duties as assigned.

Requirements:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

High school diploma or equivalent.
Currently licensed to practice as a professional Registered Nurse (RN) in the state of Missouri.
3-5 years of recent hospital-based patient care required.
3-5 years Milliman or InterQual experience preferred.
HMO, managed care, PPO, Utilization Management/medical management experience is a plus.
Strong computer skills, excellent communication skills, team building, and leadership ability.
Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic.

PHYSICAL/MENTAL REQUIREMENTS

Must be able to sit and stand, intermittent 8 to 10 hours a day.
Must be able to use standard office equipment, including the telephone and computer keyboard.
Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
Occasionally walks on uneven surfaces.

Quick Apply

Refine Your Search

nurse case manager jobs in warrensburg, mo

Utilization Review RN

Hospice LPN

Inpatient Therapist Lead

Case Manager - RN

Travel ICU RN Job in Birmingham, Alabama

Related jobs to explore

Explore jobs in cities nearby

I want to receive the latest job alert for nurse case manager in warrensburg, mo

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected