• Hospital Care Manager, RN

    Job Locations US-NV-Las Vegas
    Posted Date 2 weeks ago(7/31/2018 5:04 PM)
    # of Openings
    Medical Management
    Culinary Health Fund
  • Overview

    CHF logo with A division of UHH



    Our mission-driven organization is focused on the “Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.


    The Culinary Health Fund serves over 50,000 workers in the hospitality and gaming industry. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!



    Key Attributes:


    • Integrity – Must be trustworthy and principled when faced with complex situations

    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required

    • Communication – Ability to generate concise, compelling, objective and data-driven reports

    • Teamwork – Working well with others is required in the Fund’s collaborative environment

    • Diversity – Must be capable of working in a culturally diverse environment

    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise

    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)



    The Medical Management department is participant focused and strives to provide the best possible care for the participants through Utilization Review and Utilization Management services, Care Coordination and Population Health Management.  The Medical Management department also assists participants in receiving care with specialists outside the service area when appropriate. The Department is designed to ensure the delivery of high quality, cost efficient healthcare for our participants and families through coordinating care, providing detailed discharge plans, advising participants of different programs available and providing face to face and telephonic education. Work with participants in the acute hospital and lower level of care settings to help guide them through the continuum of care. Will assess, plan, implement, coordinate, monitor, and evaluate care options and services to meet our participants’ health care needs. In conjunction with the Transition Management Team, this position is responsible for ensuring that the discharge plan is achieved in a timely manner and effectively meets the patients’ needs.



    - Work with participants of all ages in the acute hospital and lower level of care settings (LTAC, SNF, Rehab) to help them through the continuum of care

    - In collaboration with the attending physician, responsible for continuous communication with all parties involved in the plan of care and decision-making to determine medical necessity and appropriateness of care for service utilization and expense

    - Daily redirect patients to Hospitalist physicians per guidelines

    - Daily communication with attending physicians regarding treatment and discharge planning needs of the patient

    - Participant in weekly status calls with the leadership team regarding respective patient care issues

    - Provide the necessary interventions to assure effective and efficient discharge planning

    - Research patient issues, barriers to care and report findings to management

    - Coordinate and attend family conferences for difficult discharge planning i.e. hospice, long term care, non-compliance

    - In conjunction with the hospital staff, coordinate hospital to hospital transfers

    - Maintain comprehensive, accurate and up-to-date record of patient care

    - Identify delays in care and send to physician reviewer for non-certification

    - Identify quality issues and refer to the Quality Committee for review

    - Serve as liaison between participant and physician to ensure timely completion of disability forms

    - Delegate non-nursing functions to Transitional Care Coordinators

    - Assist management in development of protocols and procedures as they relate to UM/CM Participate in the weekend on call rotation

    - Perform benefit education to participants and providers

    - Perform other duties as assigned within the scope of responsibilities and requirements of the job



    - Knowledge of Microsoft Office

    - Bi- or Multi- lingual skills (written and verbal): Strongly Desired


    Ability to:

    - Communicate clinical information to non-clinical individuals

    - Manage competing deadlines and multiple projects in a fast-paced environment Excellent written and verbal communication skills

    - Excellent interpersonal skills – ability to express compassion and balance the emotions with business needs

    - Strong analytical skills

    - Must be able to lift 20lbs, endure prolonged standing, walking, and climbing stairs. Perform the essential functions of this job with or without reasonable accommodation If required, must be able to provide current driver’s license without restrictions

    - If required, must be able to provide active car insurance policy


    Education/Minimun Requirements:

    License: Unrestricted active Nursing License in the State of Nevada

    Willingness and ability to obtain a license in other States as may be required by the Fund

    Minimum Years’ Experience: Minimum of 3 overall years’ Nursing experience, with 2 years in a(n) hospital environment required.

    Experience with Case Management and Managed Care preferred



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