The nurse case manager collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient’s progress, intervening appropriately to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective. Conduct concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, accrediting bodies, and other state agencies. Prospectively or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines and insurance benefits and communicates information to payers in accordance with contractual obligations. Serve as a resource to the physicians and provide education and information on resource utilization, national and local coverage determinations, and use of hospital admission criteria.
Required: Graduate of an accredited school of nursing
Preferred: Bachelor’s of Nursing with knowledge of InterQual Level of Care Criteria and/or Milliman Care Guidelines and of local/national coverage determinations; familiarity with SIMS procedure indicators and inpatient only listings.
Required: Minimum of 3 years hospital experience.
Excellent interpersonal skills, including ability to be genuine and empathetic
Excellent communication (verbal and written) skills with attention to detail
Ability to interact professionally and contribute to the interdisciplinary team
Current RN License in the state of Missouri
Cox Medical Center Branson is a full-service hospital caring for residents of and visitors to Stone and Taney counties. From our newly expanded and renovated Emergency Room and critical care areas, to our new Women’s Center, Cox Medical Center Branson offers the care you need, right here.