"Case Management Registered Nurse 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
Full Time Days
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 You Will Need:
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.
Knowledge of Interqual, utilization review, and discharge planning regulations preferred.
Knowledge/experience with DRG and ICD-9 coding 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
ACM, CCM, or other Case Management certification 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 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.
The Case Manager must complete all initial admission assessments within 24 hours of inpatient admission and match the patient'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.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
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.
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