**Description:**
CHI Health is a regional health network with a unified mission: nurturing the healing ministry of the Church while creating healthier communities. Headquartered in Omaha, the combined organization consists of 15 hospitals, two stand-alone behavioral health facilities and more than 150 employed physician practice locations in Nebraska and southwestern Iowa. More than 12,000 employees comprise the workforce of this network that includes 2,820 licensed beds and serves as the primary teaching partner of Creighton University’s health sciences schools. In fiscal year 2014, the organization provided a combined $149.3 million in quantified community benefit including services for the poor, free clinics, education and research. With locations stretching from Kearney, Neb. to Missouri Valley, Iowa, the health network is the largest in Nebraska and serves residents of Nebraska and southwest Iowa. For more information, visit online at CHIhealth.com.
*Job Summary/Essential Duties:*
• Recommend and implement the philosophy, policies and procedures for care coordination, utilization review, discharge planning, and social services.
• Assign and manage day-to-day care coordination, utilization review, discharge planning, and social services activities on the clinical units, to include admission, transfer, discharge and throughput.
• Act as liaison with the medical staff and Physician Advisor(s) to facilitate care coordination throughout the organization.
• Problem-solve day-to-day issues regarding Utilization Review and keep appropriate individuals informed of matters of risk to the organization.
• Manage/provide for necessary exchange of patient information to intake coordinators and third-party payers, as well as internal departments such as HIM, Revenue Cycle, Managed Care, and Patient Accounting to facilitate the processing of claims and address denials.
• Maintain logs, medical records and other documentation needed to demonstrate compliance with CMS, QIO, accrediting and other government regulatory bodies.
• Monitor and manage resource utilization trends and patterns with comparison to both internal external benchmarks and individual hospital standards.
• Provide information regarding changes in Medicare regulations and documentation issues to physicians, administration and staff as needed.
Hours: Every third weekend and 8 hour shifts
**Qualifications:**
Education:
1. Bachelor’s degree in clinical area required.
2. Bachelor of Science in Nursing preferred.
3. Bachelor of Science in Nursing (BSN) required within 5 years of date of hire.
4. Equivalent combination of education, training, and experience may substitute for education requirements.
Licensure/Certification:
1. Current healthcare professional licensure as Registered Nurse, LPN, Respiratory Therapist, Physical Therapist, Occupational Therapist or Social Worker required.
2. Valid Basic Life Support (BLS) certification required.
3. Appropriate certification in Case Management preferred; for example, Commission for Case Manager Certification (CCMC).
Experience/Pre-Requisites:
1. Minimum three years’ experience in Hospital Case Management.
2. Individual will have experience that would produce an understanding of insurance, workers compensation and/or medical management.
Consistently adheres to and demonstrates our Core Values of*Reverence, Integrity, Compassion and Excellence*.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers. CB
**Job:** Nursing - RN
**Primary Location:** NEBRASKA-LINCOLN-SAINT ELIZABETH REG MED CTR
**Shift:** Day/Evening
**Scheduled Hours per 2-week Pay Period:** 72
**Weekends Required:** Occasional
**Req ID:** 2015-R0022574