Fresno Heart & Surgical Hospital (FHSH) is a unique specialty hospital in Central California known for its luxurious accommodations, excellent patient experience and five-star cardiac, vascular and bariatric surgery services. Healthgrades and patients alike, have rated our facility among the top California hospitals when it comes to providing a healing environment. More than 90% of patients surveyed indicated they "would definitely" recommend us to family and friends. Healthgrades also ranks us in the top 5% nationally, recognizing our hotel-like environment and service with the Outstanding Patient Experience Award, eight years in a row. We have 48 private patient suites that are able to accommodate a patient's overnight guest. Also, an additional nine private intensive care suites. We are a technologically advanced facility with surgical suites that promote minimally-invasive techniques for cardiac, vascular, bariatric and general surgery.
We provide excellent health benefits (medical, dental & vision) along with a 403(b) and Pension packages to plan for your future. Additionally, you will accrue paid time off (PTO) from your first day of employment, totaling 5 weeks as a full-time employee. Other Benefits include; Long-term Disability Insurance, Basic Life Insurance and Accidental Death and Dismemberment Coverage, Educational Reimbursement, Employee Assistance Program, Credit Union Membership, Retirement Planning classes, a Fitness Center on the CRMC campus and concierge service.
Under the direction of the Director and Manager of Case Management performs retrospective medical record chart review and provide clinical medical necessity reviews and appeals in response to payer denials. Serves as a resource and is responsible for the oversight and daily operations. Assists the manager with providing support to the department, including maximizing personnel abilities and competencies, problem resolution, department orientation, and education. Assumes responsibility for the Denial and Appeals personnel to assure that assigned tasks or duties are completed within appropriate time standards, while providing quality of service. Functions as a resource person to Case Management, the Command Center, the Business Office, and the Medical Records department to coordinate timely communication and to ensure accurate reimbursement.
Associate's degree in Nursing. Two years acute hospital Case Management experience, preferably in med/surg and two years supervisory experience. PREFERRED: Bachelor's degree in Nursing. LICENSES/CERTIFICATIONS MINIMUM REQUIRED: Current CA Registered Nurse license. Certified Case Manager (CCM) or Accreditation in Case Management (ACM). InterQual certification within 1 year of hire.