• Minimum 3-5 yearsâ™ Registered Nurse experience in an acute care hospital required.
• Minimum 2 yearsâ™ experience in hospital utilization review, care coordination, discharge planning or has experience in a community-based care management role with commercial payers, inpatient rehab hospital care management, or home care services care manager role.
• Registered Nurse Case Manager hired into the case management department with limited experience in a hospital- based clinical case management program may participate in an orientation, education and departmental preceptorship program.
• Current Florida RN license; BLS-American Heart Association
• Graduate of an accredited School of Nursing
• Excellent knowledge of the denial/appeal process, Governmental and Third party payers audit processes.
• Knowledge of medical necessity monitoring tools- InterQual, Milliman Care Guidelines (MCG), principles of Managed Care, Computer applications, including but not limited to: Windows, Outlook, Excel and Microsoft Word.
• Critical thinking/problem solving skills.

Job Summary:

The Registered Nurse-Clinical Case Manager, in collaboration with physicians, and other interdisciplinary team members provide patient care coordination, care planning, facilitation and coordination of discharge needs for hospitalized patients in the acute care setting, and or during the emergency room discharge process. The underlying objectives are enhancing the quality of clinical outcomes, patient satisfaction, while managing the cost of care. The Clinical Case Manager strives to promote patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and appropriate level of care for patients during hospitalization and on a continuum after discharge.