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

Palmetto General Hospital; Florida; On-site; USD 65,000 - 90,000; Full time

Job summary

Palmetto General Hospital in Florida is seeking a Case Management RN to perform activities ensuring medical necessity of admissions and the appropriateness of continued stay using Interqual criteria. The role involves collaborating with patients, families and health care professionals to develop and monitor care plans.

Responsibilities include evaluating daily patient progress, adjusting plans to improve outcomes, and maintaining confidential communications with physicians and the

Qualifications

• Must be able to use the medical record for Interqual reviews.
• Three or more years of acute care hospital experience preferred.
• Fluent in written and spoken English.

Responsibilities

• Perform Case Management activities to ensure medical necessity of admissions and appropriate continued stay using Interqual guidelines.
• Monitor resource utilization across patients and coordinate care plans with patients, families, and health care professionals.
• Evaluate daily patient progress and adjust care plans to improve outcomes.
• Maintain confidential communications with physicians and multi-disciplinary staff.

Skills

Communication

English Proficiency

Acute Care Experience

Interqual Knowledge

Medical Record Review

Outlook/EMR Proficiency

Medical-Surgical/ICU Experience

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