"RN Case Manager PRN Days" AdventHealth North Pinellas
Location Address: 1395 S Pinellas Avenue, Tarpon Springs, Florida 34689
Top Reasons to Work At AdventHealth North Pinellas
Top Quality outcomes
Nurse Excellence Committee (NEC)/Governance
Leadership is accessible
Located on the Gulf of Mexico
You Will Be Responsible For:
Â· Facilitate clinical patient progression through a defined plan of care to achieve optimal outcomes.
Â· Facilitate a physician-specific plan of care, ensure appropriate resource utilization, and coordinate utilization review and approval by a payer.
Â· Support or coordinates discharge planning services and act as an effective member of the interdisciplinary team in improving quality, services, and financial aspects of overall patient care management.
Â· Complete all initial utilization reviews within 24 hours of inpatient admission.
Â· Conduct concurrent reviews as appropriate per payer requirements and the Utilization Management Plan.
Â· Evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the case load according to Case Management Department Plan, policies and procedures.
Â· Demonstrate knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner.
Â· Participate in discharge planning role by completing initial discharge planning assessments, formulating and implementing an appropriate discharge plan.
Â· Function in a team approach to coordinate appropriate and safe discharge planning from the newborn to the geriatric patient.
What You Will Need:
Florida RN license
Diploma or AS in Nursing
Five (5) years prior work experience in an acute care hospital as a Registered Nurse.
Individuals must possess these knowledge, skills and abilities and be able to explain and to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.
Experience with PC applications required. (Such as word processing, spreadsheet and graphics)
Knowledge/experience with DRG and ICD-9 coding preferred.
Must have excellent interpersonal skills, written and oral communication skills.
Excellent organizational skills and high degree of self-motivation highly desirable.
Knowledge of Interqual, utilization review, and discharge planning regulations preferred.
Minimum of one (1) year prior experience in a Case Manager or Utilization Management role.
OR (If Applicable): Any combination of education, training or experience that provides the knowledge, skills and abilities required to successfully accomplish the assigned duties and responsibilities of the position.
CCM or other Case Management certification preferred; experience with data analysis and interpretation preferred.
The Case Manager functions as a member of an organization-wide team promoting excellent overall case management of patients admitted to the hospital in either inpatient or observation status. The case manager combines their professional knowledge base and experience with critical thinking skills and an organized team approach to meet organizational goals for outcome indicators such as length of stay and readmissions. The Case Manager must have the professional ability to practice under minimal supervision and perform the following seven essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation, with emphasis on decreasing length of stay and monitoring cost effective health care across the continuum of care. The Case Manager maintains accountability for facilitating clinical patient progression through a defined plan of care to achieve optimal outcomes. The Case Manager utilizes professional knowledge to facilitate a physician-specific plan of care, ensure appropriate resource utilization, and coordinate utilization review and approval by a payer. The Case Manager supports or coordinates discharge planning services and acts as an effective member of an interdisciplinary team in improving quality, service, and financial aspects of overall patient care management. This position is required to have competence to assess and case manage all age groups as indicated by the license of a Professional Registered Nurse. The Case Manager will provide care, treatment, and services within the scope of their license, certification, registration, and/or assessed competencies. Practice will be in accordance with laws and regulations.
The Case Manager must complete all initial admission assessments within 24 hours of inpatient admission and match the patientâ™s ongoing needs with the appropriate level and type of medical, health, psychosocial, or social service as they relate across the continuum of care. The Case Manager evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the case load according to Case Management Department Plan, policies and procedures. The Case Manager must meet Department expectations to affect practice variations and enhance patient outcomes. Demonstrates knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner. Functions in a team approach to coordinate appropriate and safe discharge planning from the newborn to the geriatric patient
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.