RN Case Manager /Utilization Review - Per Diem - Days - Hybrid - MHS

Location:

Fort Lauderdale, Florida

We have an outstanding reputation for providing patient- and family-centered care that exceeds all expectations. Together, we have created an award-winning, nationally-recognized system where every effort is focused on delivering exceptional care throughout our communities. Career opportunities exist on diverse teams across our many facilities where you can search open positions and apply online to join #teamMHSflorida.

Learn more below.

Summary:

The Utilization Management RN uses evidence-based medical necessity screening tools to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures, and an estimation of the patient’s expected length of stay. The Utilization Management RN follows the Utilization Review (UR) process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

Responsibilities:

Addresses system-level issues impeding diagnostic or treatment progress with the healthcare team and reports unresolved opportunities for improvement through the organizational defined escalation process (chain-of-command structure). Proactively identifies and resolves barriers to timely discharge/transition and documents avoidable delays information in accordance with health system protocols.Conducts an in-depth case management assessment of a patient’s needs at the time of admission and throughout the patient’s stay. Obtains and confirms information necessary for the development of a comprehensive discharge/transition plan of care.Clinically assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs to facilitate a safe and timely discharge to the next appropriate post acute level of care.Collaborates with the Social Worker to proactively identify the need for team and/or patient and family conferences to facilitate discussion of the patient’s condition, discuss prognosis and determine an agreed upon transition of care plan.Consults with Physicians and multidisciplinary teams regularly to evaluate the patient's status and appropriateness of medical care, including admission, length of stay, transfer, and discharge.Performs ongoing chart review to identify actual or potential issues, which may include service delivery, patient outcomes, and satisfaction, compliance, cost, and reimbursement.Actively coordinates progress and the patient’s care by monitoring the length of stay (LOS) of the patient’s hospitalization, leads and facilitates rounds, and proactively works to meet expected length of stay and clinical targets/indicators.Monitors patient and family satisfaction. Responds to questions and complaints from patients, family members, and payers regarding care.Performs duties in a manner that promotes quality patient care/satisfaction, while promoting safety, cost efficiency, and a commitment to the continuous quality improvement process.

Competencies:

ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CLINICAL POLICIES AND STANDARDS, CUSTOMER SERVICE, DISCHARGE PLANNING CLINICAL EFFECTIVENESS, PATIENT AND FAMILY CENTERED CARE, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, TEAM WORK

Education and Certification Requirements:

Accredited Program: Nursing (Required)Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL)

Additional Job Information:

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work with minimal supervision. Current sound clinical knowledge; knowledge of medical literature, research methodology, and financial/reimbursement issues. Knowledge of CMS, commercial payer requirements and hospital financial/reimbursement processes. Ability to work collaboratively and proactively with healthcare teams and other hospital-based interdisciplinary teams. Must be able to work in a stressful environment and take appropriate action. Required Work Experience: Two (2) years of nursing experience. One (1) year of experience in utilization management or case management preferred. Other Information: Certification in utilization management and/or case management preferred.

Working Conditions and Physical Requirements:

• Bending and Stooping = 40%
•  Climbing = 0%
•  Keyboard Entry = 100%
•  Kneeling = 0%
•  Lifting/Carrying Patients 35 Pounds or Greater = 0%
•  Lifting or Carrying 0 - 25 lbs Non-Patient = 40%
•  Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
•  Lifting or Carrying > 75 lbs Non-Patient = 0%
•  Pushing or Pulling 0 - 25 lbs Non-Patient = 0%
•  Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
•  Pushing or Pulling > 75 lbs Non-Patient = 0%
•  Reaching = 60%
•  Repetitive Movement Foot/Leg = 0%
•  Repetitive Movement Hand/Arm = 60%
•  Running = 0%
•  Sitting = 80%
•  Squatting = 0%
•  Standing = 0%
•  Walking = 0%
•  Audible Speech = 80%
•  Hearing Acuity = 80%
•  Smelling Acuity = 0%
•  Taste Discrimination = 0%
•  Depth Perception = 80%
•  Distinguish Color = 40%
•  Seeing - Far = 40%
•  Seeing - Near = 80%
•  Bio hazardous Waste = 0%
•  Biological Hazards - Respiratory = 0%
•  Biological Hazards - Skin or Ingestion = 0%
•  Blood and/or Bodily Fluids = 0%
•  Communicable Diseases and/or Pathogens = 0%
•  Asbestos = 0%
•  Cytotoxic Chemicals = 0%
•  Dust = 60%
•  Gas/Vapors/Fumes = 0%
•  Hazardous Chemicals = 0%
•  Hazardous Medication = 0%
•  Latex = 0%
•  Computer Monitor = 80%
•  Domestic Animals = 0%
•  Extreme Heat/Cold = 0%
•  Fire Risk = 0%
•  Hazardous Noise = 0%
•  Heating Devices = 0%
•  Hypoxia = 0%
•  Laser/High Intensity Lights = 0%
•  Magnetic Fields = 0%
•  Moving Mechanical Parts = 0%
•  Needles/Sharp Objects = 0%
•  Potential Electric Shock = 0%
•  Potential for Physical Assault = 0%
•  Radiation = 0%
•  Sudden Decompression During Flights = 0%
•  Unprotected Heights = 0%
•  Wet or Slippery Surfaces = 0%

Shift:

Days

Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [email protected]