Registered Nurse Case Manager PRN
Req #: 17011649
Location: Zephyrhills, FL
Job Category: Case Management
Organization: Florida Hospital Zephyrhills
Potential Referral Bonus: $
Florida Hospital Zephyrhills
Florida Hospital Zephyrhills has provided faith-based, whole person care to our community for more than 30 years. This means we build trust, create belonging and deliver hope, thereby extending the healing ministry of Christ, when caring for our patients
. Our 139-bed facility includes an Accredited Chest Pain Center with PCI, Heart Institute, Primary Stroke Center, emergency department, state-of-the-art operating rooms, Bone & Joint Center, Simpson Breast Health Center and the area’s only Obstetrics Program, The Baby Place, offering family-centered maternity care. Other special services include, a Center for Wound Healing, CREATION® Health Wellness Center, CREATION® Health Spa, home health, imaging center, cardiopulmonary rehabilitation, and physical, occupational, and speech therapy.
You will be responsible for:
- 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.
- Performs all aspects of Case Management in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.
- Treats patients and families with respect and dignity.
- Maintains and respects confidentiality of patient/physician/personnel information
- Able to communicate with physician regarding discharge planning needs of the patient. Assists the physicians and other care givers to facilitate post-hospital care.
- Assures prompt communication of information required for timely discharge.
- Is knowledgeable of medical necessity criteria for Medicare, Medicaid, HMO and private insurance coverage.
- Maintains current knowledge of resources available within the community, provides resource materials to be patients when needed. Is able to obtain other resources as needed.
- Communicates daily with appropriate personnel regarding admissions and discharges to various units.
- Initiates ongoing communication with the patient and patient’s; family regarding discharge needs.
- Communicates with family members and caretakers regarding the needs of the patient and anticipated discharge plans.
- Interacts professionally with patient/family and involves patient/family in the formation of the discharge plan.
- Documents discharge planning in an ongoing manner. Consistently provides complete and accurate discharge planning notes.
- Is knowledgeable of patient’s financial status, diagnosis and discharge needs.
- Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
- Acts on performance improvement issues identified on assigned unit or related to assigned patients.
- Cooperates with review activities of insurance company, based on information received.
- Collaborates with the Patient Financial Services staff and onsite case workers where patients require such assistance.
- Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
- Demonstrates an ability to be flexible, organized and function under stressful situations. Interacts professionally and effectively in all situations with patients, families, staff, and outside vendors.
- Has a working knowledge of Interqual review criteria and the ability to apply accurately.
- Performs timely UR reviews using Interqual criteria as well as clinical documentation.
- Seeks additional information from the physician as necessary to support admission status.
- Faxes clinical reviews in a timely manner and assures accuracy and receipt of fax.
- Performs discharge reconciliation to assure completeness & accuracy.
- Completes readmission reviews in timely manner.
- Assures discharge plan in place for high risk for readmission to assure patient’s disease management outside of the hospital.
- Work assertively and creatively to move patients quickly to discharge foreseeing and avoiding any potential barriers to assure appropriate length of stay.
- Maintains a good working relationship both within the department and with other departments.
- Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
- Documentation meets current standards and policies.
- Consistently demonstrates customer service and world class behaviors and attitudes in every situation.
What will you need:
- 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.
- Knowledge of Interqual, utilization review, and discharge planning regulations (Preferred).
- Knowledge/experience with DRG and ICD-9 coding (Preferred).
- Minimum of Diploma or AS in Nursing
- Two (2) years prior work experience in an acute care hospital as a Registered Nurse.
- Prior experience in a Case Manager or Utilization Management role (Preferred).
- 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 (Preferred).
- Experience in Home Healthcare, Hospice, or skilled nursing facilities (Preferred).
- Florida RN license
- ACM, CCM, or other Case Management certification (Preferred).