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Admission and Denials Care Mgr

Thanks for your interest in Children's Mercy!

Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference, which is why we have been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years.

Children’s Mercy is in the heart of Kansas City – a metro abounding in cultural experiences, vibrant communities and thriving businesses. This is where our patients and families live, work and play. This is a community that has embraced our hospital and we strive to say thanks by giving back. As a leader in children’s health, we engage in meaningful programs and partnerships throughout the region so that we can improve the lives of children beyond the walls of our hospital.

Overview

The Admission and Denials Care Manager utilizes clinical expertise, critical thinking, and high level of communication during review of incoming admissions and facilitating medical denial reviews. This role works closely with the Patient Progression Hub staff, referring physicians, and accepting physicians to clinically evaluate all incoming admissions for appropriate level of care and potential community coordination to avoid unnecessary admissions. In addition, this position will review incoming medical denials and help coordinate appeals (peer-to-peers and/or appeal letters) with the appropriate provider. This position will participate in ongoing professional development activities, quality improvement, and continuing education activities.

At Children’s Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, team and integrity.

Additionally, it’s important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as the Children’s Mercy staff, we want to let you know that the seasonal influenza and COVID-19 vaccines are a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005. If you become a finalist for this position, and have any concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.

Responsibilities

Facilitate timely and proper patient throughput progression, centered around interdisciplinary communication.

Evaluate appropriateness of each admission using evidence-based clinical guidelines to ensure correct bed status.

Performs denial and appeal management processes to attempt securement of reimbursement for services rendered at the appropriate level of care.

Participate in ongoing professional development activities, making a meaningful contribution to quality improvement and continuing education of self and others.

Qualifications

Bachelor's Degree BSN and 5-7 years experience Experience as a care manager or demonstrated leadership skills in a previous role

One of the following: Registered Nurse Multistate License Missouri, Licensed RN - MO required upon hire

One of the following: Registered Nurse Multistate License Kansas, Licensed RN - Kansas required upon hire

RN Compact license for all states besides KS and MO

One of the following: Certified Case Manager, American Case Management required upon hire

Refer to Nursing and Avdance Practice Provider Licensure and Certification policy for required Life Support Certifications Required Upon Hire

Certified Case Manager (CCM) certification OR Required 1 Year

Accredited Case Manager (ACM) certification Required 1 Year

CPN Certification Preferred

Starting Pay

Our pay ranges are market competitive. The pay range for this job begins at $29.38/hr, but your offer will be determined based on your education and experience.

Remote Work/Work from Home

This position is not eligible work remotely, which means that the person hired will be required to work onsite at one of our Children’s Mercy locations and may not work from home.

EEO Employer/Disabled/Vet

Children’s Mercy hires individuals based on their job skills, expertise and ability to maintain professional relationships with fellow employees, patients, parents and visitors. A personal interview, formal education and training, previous work experience, references and a criminal background investigation all are factors used to select the best candidates. The hospital does not discriminate against prospective or current employees based on the race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry or veteran status. A drug screen will be performed upon hire. Children’s Mercy is smoke and tobacco free.

Our commitment to Diversity & Inclusion

CM is committed to creating a diverse and inclusive workforce. Our patients and families come from all walks of life, and so do we. We know that our greatest strengths come from the people who make up our team so we hire great people from a wide variety of backgrounds, not just because it’s the right thing to do, but because it makes our hospital stronger and our patient care more compassionate.

If you share our values and our enthusiasm for service, you will find a home at CM. In recruiting for our team, we welcome the unique contributions that you can bring, including education, ideas, culture, ethnicity, race, sex, sexual orientation, gender identity and expression, national origin, age, languages spoken, veteran status, color, religion, disability and beliefs.

Job Type
Full Time
Salary
N/A
Experience
N/A
Posted
70 days ago

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