AdventHealth Registered Nurse Case Manager Utilization Review Full Time in Ocala, Florida
"Registered Nurse Case Manager" AdventHealth Ocala
Location Address: 1500 SW 1 st Ave Ocala, Florida 34471
Top Reasons To Work At AdventHealth Ocala
Horse Capital of the World
Driving distance to Gainesville, St. Augustine, Orlando, Tampa, Sarasota
Part of the community since 1898, providing healthcare to Marion County for over 120 years
Florida Hospital Ocala offers a broad spectrum of services, with programs that are nationally recognized and accredited
Spectacular springs throughout the county
You Will Be Responsible For:
Completes timely utilization reviews using InterQual for all admissions per UM Plan. Assure correct status for payment. Meet compliance with regulatory guidelines.
Completion of twice daily utilization reviews on all observation patients to ensure correct status and timely discharge or admission.
Obtain authorization of services to assure payment for services render from commercial payer.
Manages caseload effectively to complete daily assignment and offers help if able to support achievement of team goals.
Provides quality customer service to external and internal customers both on telephone and in person to ensure courteous and professional experience.
Communicates effectively with patient, family and significant others to determine potential discharge needs.
Develops and implements discharge plans and supportive care for patient based on assessment and collaboration with the treatment team. Monitors and revises the discharge plan as needed to affect a timely discharge of patient that adequately meets patient's needs.
Participates in plan of stay rounds and provides length of stay and discharge planning information. Coordinates with the Charge RN or RN and hospitalist for daily interventions to improve patient flow.
Completion of LACE Tool on all new Inpatient admissions during initial utilization review.
Completion of 30-Day Readmission Tool on all Inpatient readmissions that occurred within 30 days.
What You Will Need:
Associate Degree in Nursing
One year of recent acute hospital case management experience required.
Current FL RN License required
See attached addendum for additional credentials
Coordinates the overall interdisciplinary plan of care for a patient, from admission to discharge. Acts as a liaison between patient/family and healthcare personnel to ensure necessary care is provided promptly and effectively. Relies on experience and judgment to plan and accomplish goals.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.