Case Manager SME Policy and Procedure Expert

Introduction

Do you want to join an organization that invests in you as a Case Manager SME? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Benefits

HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Nurse Subject Matter Advisor like you to be a part of our team.

Job Summary and Qualifications

The Case Manager SME of Hospital Case Management (HCM) will serve as a Subject Matter Advisor (SMA), applying their clinical and case management expertise to support HCA attorneys, insurance partners, and other representatives in evaluating the medical and case management components of disputes requiring Hospital Case Management involvement.

Key responsibilities include reviewing patient records, analyzing medical data, and providing testimony in legal proceedings. This individual will collaborate with local/divisional Case Management leadership and HCA’s legal team to assess the validity of claims and assist in the pursuit of payment on unpaid and underpaid claims.

Additionally, the Nurse Subject Matter Advisor will serve as a SMA for the broader corporate Case Management team, offering proactive education and guidance to help prevent recurrence of similar claim issues.

Major Responsibilities:

• Conducts comprehensive clinical record reviews and detailed claims analyses.
• Identifies and synthesizes key medical and case management issues relevant to legal proceedings.
• Stays informed on healthcare regulations, legal developments, and national/community resources impacting case management.
• Serves as a witness in cases requiring specialized Case Management expertise.
• Educates and advises teams to proactively reduce risk of non-payment on claims and prevent recurrence of similar cases.
• Supports the corporate Case Management team with ad-hoc projects and strategic initiatives.
• Demonstrates strong task and priority management to meet deadlines and deliver high-quality outcomes.
• Contributes to the design and evolution of Case Management programs, integrating current research and evidence-based practices.
• Collaborates with Case Management and Legal leadership to develop and implement policies, procedures, toolkits, training, communications, and reporting frameworks.
• Upholds the organization’s Code of Conduct and aligns with its Mission and Values.
• Performs other duties assigned, supporting the broader goals of the Case Management and Legal teams.

Reporting & Travel:

• Reports directly to a Group Vice President of Case Management.
• Requires up to 50% travel to provide onsite testimony and legal support.

Skills:

• Self-starter and collaborative team player.
• Skilled in managing multiple priorities with minimal supervision.
• Strong written, verbal, and presentation communication skills.
• Comfortable and confident in diverse settings.
• Committed to maintaining confidentiality at all times.

Requirements:

• Master’s degree in Nursing required
• 5+ years of experience in Case Management required
• 3+ years of experience in Clinical Nursing required
• 3+ years of experience in Healthcare Legal Testimony required
• 3+ years of experience in HCA Case Management highly preferred. CM knowledge and experience in multiple markets/divisions is a plus
• Legal Nurse Consultant Certified (LNCC) preferred
• Registered Nurse – Currently licensed as a register professional nurse in the state in which he or she practices, in accordance with law and regulation. Compact RN License is a plus
• Requires up to 50% travel to provide onsite testimony and legal support.

HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Nurse Subject Matter Advisor opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.