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Registered Nurse Case Manager Full Time Days

AdventHealth

This is a Contract position in Zephyrhills, FL posted January 16, 2020.

Description

RN Case Manager Full Time Days AdventHealth Zephyrhills

Location Address: 7050 Gall Boulevard Zephyrhills, Florida 33541

Top Reasons to Work at AdventHealth Zephyrhills

  • FH Zeph/Dade City Named One of America’s Best Hospitals for Heart Care, Orthopedics, Stroke Centers and Patient Safety three years in a row “2017-2019” by the Women’s Choice Award
  • Leapfrog Hospital Safety Grade A Spring/Fall 2018
  • One of only 35 Hospitals Nationally Named as a Top General Hospital by The Leapfrog Group
  • Four Star Recipient for Coronary Interventional Procedures in 2019 by Health grades
  • First in Florida to earn Advanced Certification for Total Hip and Total Knee by The Joint Commission
Work Hours/Shift:
  • FT – Days 40hr./Week
 

You Will Be Responsible For:

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

  • 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.
  • Completes initial utilization reviews within 24 hours of inpatient admission or as required by payer.
  • Conduct concurrent reviews as appropriate per payer requirements and the Utilization Management Plan.
  • 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. 
  • Demonstrates knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner.
  • Participates in discharge planning role by completing initial discharge planning assessments, formulating and implementing an appropriate discharge plan.
  • Function as part of a team to coordinate appropriate and safe discharge planning from the newborn to the Geriatric patient.
  • Responsible for performing assessments on Medicare, Medicaid and high-risk patients to determine discharge planning needs, always documents assessments.
  • Additional duties required.

Qualifications

What You Will Need:

EDUCATION AND EXPERIENCE REQUIRED:

  • Florida RN license
  • Minimum of Diploma or AS in Nursing
  • Two (2) years prior work experience in an acute care hospital as a Registered Nurse.
  • Experience with electronic patient information systems required.
  • Must have excellent interpersonal skills as well as written and oral communication skills.
  • Excellent organizational skills and high degree of self-motivation highly desirable.
 
EDUCATION AND EXPERIENCE PREFERRED:
  • ACM, CCM, or other Case Management certification preferred
  • 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.
  • Experience in Home Healthcare, Hospice, or skilled nursing facilities is a plus
 
KNOWLEDGE AND SKILLS PREFERRED:
  • Knowledge of Interqual, utilization review, and discharge planning regulations preferred.
  • Knowledge/experience with DRG and ICD-9 coding preferred.
 
JOB SUMMARY:
  • 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 appropriate resource utilization, efficiency, 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. 


This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.