RN Case Manager SMA Medical Management Las Vegas, NV

Southwest Medical Associates (SMA) is a multi-specialty group of physicians, Nurse Practitioners and Physician Assistants, consisting of over 200 providers, fourteen clinical locations including nine health care centers, five urgent care clinics and an outpatient surgery center. SMA offers patients compassion, innovation, and quality care throughout southern Nevada. SMA is headquartered in the greater Las Vegas, NV area.

The RN Case Manager for the SMA Medical Management Department  will be responsible for discharge planning, improved transitions of care, and utilization management of hospitalized health plan members. Ensure they receive quality medical care in the most appropriate setting. Performs the following on a daily basis; 1) performs patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial); 2) develop individualized discharge plans that involve provider, patient and caregiver goals for successful transitions of care; 3) implement discharge plan involving health care resources across the continuum; and 4) monitor and report variances that may challenge timely quality care. 

***This position is primarily telephonic based at the 2716 North Tenaya location, will travel onsite to local facilities as needed***

Primary Responsibilities:

• 
  

  Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care

  
  
• 
  

  Utilize both company and community based resources to establish a safe and effective case management plan for hospitalized members

  
  
• 
  

  Collaborate with patient, family and health care providers to develop an individualized plan of care that encompasses both acute care episode and post hospital discharge plan

  
  
• 
  

  Communicate with all stakeholders the required health related information to ensure quality coordinated care and services are provided expeditiously to all hospitalized members

  
  
• 
  

  Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team

  
  
• 
  

  Utilize approved clinical criteria to assess and determine appropriate level of care for hospitalized members

  
  
• 
  

  Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan

  
  
• 
  

  Accountable to understand role and how it affects utilization management benchmarks and quality outcomes