Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1876071

Palmetto-General-Hospital; Florida; On-site; USD 70,000 - 95,000; Full time

Job summary

Palmetto-General-Hospital is seeking a Case Manager RN to ensure medical necessity of admissions and appropriate continued stay using Interqual guidelines. You will monitor resource use and collaborate with physicians and care teams to implement effective care plans.

Daily assessment of patient progress, adjusting plans as needed, and maintaining confidential communication with the care team. Requires Florida RN licensure and BLS; preferred experience in Medical-Surgical, Telemetry, Critical

Qualifications

• Fluent in written and spoken English.
• Current Florida RN Licensure; BLS Certification.
• Must possess solid clinical background for Medical Record review.

Responsibilities

• Perform Case Management activities to assure medical necessity of admissions and appropriateness of continued stay using Interqual Guidelines.
• Monitor utilization of resources for all patients reviewed.
• Communicate with physicians, families, and multi-disciplinary teams to implement care plans and adjust as needed.

Skills

Communication

English fluency

Interqual reviews

Outlook

Medical record review

Tools

Outlook

EMR / electronic medical records

Job description

Position Summary:

Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources of all patients reviewed. Working with clients, family and friend support networks and health care professionals to put care plans in place. Evaluating clients' progress daily and making adjustments as needed to improve outcomes. Maintains confidential communication with physicians and multi-disciplinary personnel to meet individual needs or the patients served. Functions as an independent contributor as well as a team member.

Position Qualification:

• Communication is an essential skill requiring the ability to see, hear, and speak.
• Fluent in written and spoken English.
• Must be able to fulfill the essential functions of the position.
• Possess three or more years of acute care hospital experience preferred.
• Familiar with the operations of the healthcare industry and healthcare delivery systems.
• Able to use the medical record in order to obtain clinical information to perform Interqual reviews.
• Utilize Outlook, and the computer based systems to perform reviews/CM assessments/CM tasks.
• Work experience in Medical-Surgical, Telemetry, Critical Care, and/or Pediatrics, NICU preferred.

Required Licenses/Certifications:

• Current Florida RN Licensure BLS Certification.
• Must possess a solid clinical background to accomplish extensive Medical Record review.
• Computer skills

Communication Skills:

• Ability to effectively communicate in writing and orally with all levels of the organization