Posted in General Business 30+ days ago.
Type: Full-Time
Description
"RN Case Manager PRN Days" AdventHealth North Pinellas
Location Address: 1395 S Pinellas Avenue, Tarpon Springs, Florida 34689
Top Reasons to Work At AdventHealth North Pinellas· Facilitate clinical patient progression through a defined plan of care to achieve optimal outcomes.
· Facilitate a physician-specific plan of care, ensure appropriate resource utilization, and coordinate utilization review and approval by a payer.
· Support or 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.
· Complete all initial utilization reviews within 24 hours of inpatient admission.
· 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.
· Demonstrate knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner.
· Participate in discharge planning role by completing initial discharge planning assessments, formulating and implementing an appropriate discharge plan.
· Function in a team approach to coordinate appropriate and safe discharge planning from the newborn to the geriatric patient.
Qualifications
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 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.
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