Clinical Coordinator- utilization Review Supervisor, Utilization Review, Full Time, Days

3 months ago

Miami, United States Jackson Health Full time

Department: Jackson Memorial Hospital - Utilization Review Case Management (two openings)

Address: 1611 NW 12 Ave, Miami, FL 33136

Shift Details: 8:00 am - 4:30 pm, Monday-Friday with weekends occasionally (primarily remote)


Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida. We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success. Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals.

Summary

The Clinical Resource Coordinator is a professional member of the health care team who has 24hour/7day accountability for the coordination, monitoring and management of patient care resources to promote cost effective delivery of patient care services at the appropriate level while maintaining a standard of quality patient care for all patient populations. The Clinical Resource Coordinator acts as a resource to all levels of staff in defining / implementing and evaluating patient care and nursing practice standards utilizing clinical expertise, the nursing process, current concepts/principles of case management/utilization management/disease management, quality improvement, clinical practice and health care trends. This professional member of the healthcare team maintains compliance with current regulatory standards and new regulatory regulations, clinical and financial, and promotes such compliance as part of daily operations amongst all team members. The Clinical Resource Coordinator performs specific job criteria/performance standards according to prevailing applicable Jackson Health System, professional and regulatory standards.

Responsibilities

  • Leads the assessment, planning, implementation and evaluation for new department models/initiatives. 
  • Identifies practices issues, systems issues and trends utilizing medical criteria, clinical data systems and protocols. 
  • Performs problem resolution activities to maintain quality patient care. 
  • Presents at administrative meetings. Case Management and Social Work metrics and productivity to include but not limited to: length of stay (LOS), case mix index (CMI), discharge barriers, resource utilization, discharge planning and level of care. Management oversight of patient throughput: assessment and evaluation to determine appropriate level of care and appropriate admission status (inpatient, observation, outpatient procedure), beginning with point of entry continuing through discharge. 
  • Follow up in the outpatient setting for patients enrolled in the CRM Placement EDP program.
  •  In the event that Manager for Clinical Resource Management is not available, visit facilities to evaluate and determine patient appropriateness in the current level of care as needed. 
  • Work in collaboration with Manager for Clinical Resources Management to transition CRM Placement EDP program patients to the appropriate level of care as needed. 
  • Management oversight of the Clinical Care Coordinator's performance regarding the level of care along the continuum (e.g. effectiveness of medication, treatments, pain status, discharge plans) and individualizing the plan of care including their role in re-enforcing teachings and discharge planning. 
  • Maintain leadership visibility, supporting service excellence initiatives and focusing on improved employee satisfaction. 
  • Rounding on patient units to identify barriers to staff performance and discharge barriers. 
  • Create and implement Corrective Action Plans (CAP) for problem resolution and escalation of issues/problems preventing efficient performance. 
  • Coordinates day to day CRM operations for designated areas including program development/implementation/outcomes, staffing, liaison with PROS / MCOS / regulatory/community agencies, revenue cycle department, length of stay initiatives, Physician Adviser activities and evidenced based practices. 
  • Provides management oversight for referral and problem resolution of complicate discharges. 
  • May provide management oversight for referral and problem resolution of complex discharges. 
  • Collaborates with family, Attending physician, Chief Utilization Officer, Utilization Management Committee, and Discharge services providers for a safe discharge plan. 
  • Concurrent review of employee schedules for appropriate staffing coverage based on patient census. 
  • Collaboration with the Chief Utilization Officer related to the Utilization Management Committee, case consultation activities, negotiation of patient placement at appropriate level of care and evaluation of patient's medical plan of care. 
  • Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). 
  • Performs all other related job duties as assigned.


Experience

  • Generally requires 3 to 5 years of related experience.

Preferred Experience

  • Clinical experience as Utilization Review RN in hospital acute care setting, strongly preferred.
  • Leadership experience in case management, highly preferred.
  • Experience with using InterQual or MCG guidelines, highly preferred.

Education

  • BSN or Bachelor's degree in related field is required. Master's degree is preferred.

Credentials

  • Valid Florida RN license is required. 
  • American Heart Association Basic Life Support (BLS) and any additional applicable life support certification for Healthcare Providers is required upon hire with at least 6 months validity and maintenance at JHS for the duration of employment. 
  • Must meet and maintain valid and current all unit specific and organizational skills/competencies, certifications/licensures, as required by regulatory and/or nursing standard of practice for the specialty.


Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.


  • Clinical Coordinator- utilization Review Supervisor, Utilization Review, Full Time, Days

    3 months ago

    Miami, Florida, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - Utilization Review Case Management (two openings)Address: 1611 NW 12 Ave, Miami, FL 33136Shift Details: 8:00 am - 4:30 pm, Monday-Friday with weekends occasionally (primarily remote)Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of...

  • Clinical Coordinator

    3 months ago

    Miami, United States Jackson Health System Full time

    JOB DESCRIPTION Department: Jackson Memorial Hospital - Utilization Review Case Management (two openings) Address: 1611 NW 12 Ave, Miami, FL 33136 Shift Details: 8:00 am - 4:30 pm, Monday-Friday with weekends occasionally (primarily remote) Why Jackson Memorial Hospital:  Jackson Memorial Hospital is the flagship hospital for Jackson Health System and...

  • Utilization Review Associate Director RN, Case Management, Full Time, Days

    4 weeks ago

    Miami, Florida, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - Utilization Review Case Management LeadershipAddress: 1611 NW 12 Ave., Miami, FL 33136Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a...

  • Utilization Review Associate Director RN, Case Management, Full Time, Days

    4 weeks ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - Utilization Review Case Management LeadershipAddress: 1611 NW 12 Ave., Miami, FL 33136Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has...

  • Utilization Review Associate Director RN, Case Management, Full Time, Days

    3 weeks ago

    Miami, United States Public Health Trust of Dade Co Full time

    Department: Jackson Memorial Hospital - Utilization Review Case Management Leadership Address: 1611 NW 12 Ave., Miami, FL 33136 Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a...

  • Registered Nurse Case Manager

    1 week ago

    Miami, United States Public Health Trust of Dade Co Full time

    Department: Public Health Trust of Dade Co - Case Management, Utilization ReviewShift Details:Per Diem, Day Shift, 8:00 am-4:30 pm (Remote work available during weekdays, 4 shifts per month)About Public Health Trust of Dade Co: The Public Health Trust of Dade County is dedicated to providing exceptional healthcare services and community support. With a...

  • Senior Director, Case Management Utilization Review, Jackson Memorial Hospital, Full time, Days

    1 week ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - CCC Case Management Utilization ReviewAddress: 1611 NW 12 Ave, Miami, FL 33136Shift details: Full time, Days Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century....

  • Case Manager RN, Utilization Review Case Management, Per Diem, Days

    2 months ago

    Miami, United States Public Health Trust of Dade Co Full time

    Department: Jackson Memorial Hospital- Case Management, Utilization Review Address: 1611 NW 12 Ave, Miami, FL 33136 Shift details: Per Diem, Day Shift, 8:00 am-4:30 pm (Local remote, available to work during the week, 4 shifts per month) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has...

  • Registered Nurse Utilization Review, Case Management, FT, 8:30A-5P

    3 weeks ago

    Miami, Florida, United States Baptist Health South Florida Full time

    Baptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of...

  • Case Manager RN, Utilization Review Case Management, Per Diem, Days

    3 months ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital- Case Management, Utilization Review Address: 1611 NW 12 Ave, Miami, FL 33136Shift details: Per Diem, Day Shift, 8:00 am-4:30 pm (Local remote, available to work during the week, 4 shifts per month)Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and...

  • Utilization Review Case Management Associate Administrator

    2 months ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - Utilization Review Case Management Address: 1611 NW 12 Ave., Miami, FL 33136 Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility)   Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a...

  • Clinical Care Coordinator Denials RN, Case Management, Full Time, Days

    2 weeks ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - JM Case Management AcuteAddress: 1611 NW 12 Ave, MIami, FL 33136Shift details: Full Time 8:00 am - 4:30 pm, Monday-FridayWhy Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a...

  • Underground Utility Superintendent

    1 month ago

    Miami, United States Roadway Construction, LLC Full time

    Job DescriptionJob DescriptionRoadway Construction, LLC is a leading construction firm specializing in civil construction, with a focus on underground utility projects. We are dedicated to delivering high-quality infrastructure solutions on time and within budget. Our team values professionalism, collaboration, and a strong commitment to excellence.Position...

  • SFAN Care Coordinator, Full Time, Days

    1 month ago

    Miami, Florida, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - AIDS GrantsAddress: 1611 NW 12th Ave., Miami, Florida 33136Shift Details: Full-Time, Days, M-FWhy Jackson:Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history,...

  • Clinical Care Coordinator, Case Management Jackson Memorial Hospital, Full Time, Days

    3 months ago

    Miami, Florida, United States Jackson Health Full time

    Department: Jackson Memorial Hospital Case Management AcuteAddress: 1611 NW 12 Ave, Miami, FL 33136Shift Details: 4-days/ week SATURDAY-SUNDAY required, 6:30 am - 5pm (10-hours flexible)Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care...

  • SFAN Care Coordinator, Full Time, Days

    1 month ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital - AIDS GrantsAddress: 1611 NW 12th Ave., Miami, Florida 33136Shift Details: Full-Time, Days, M-FWhy Jackson:Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history,...

  • Clinical Care Coordinator, Case Management Jackson Memorial Hospital, Full Time, Days

    3 months ago

    Miami, United States Jackson Health Full time

    Department: Jackson Memorial Hospital Case Management AcuteAddress: 1611 NW 12 Ave, Miami, FL 33136Shift Details: 4-days/ week SATURDAY-SUNDAY required, 6:30 am - 5pm (10-hours flexible)Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community...

  • Chief of Public Utilities Management

    1 week ago

    Miami, United States City of North Miami Beach, FL Full time

    Salary: $131, $174,869.82 Annually Location: North Miami Beach, FL Job Type: Full-Time Department: Public Utility - NMB Water FLSA: Exempt Position OverviewThis role encompasses significant managerial and complex professional administrative responsibilities, focusing on the strategic planning, organization, staffing, direction, and oversight of the City's...

  • Accounts Receivable Specialist

    1 month ago

    Miami, United States Denovo Review Full time

    Job DescriptionJob DescriptionNational well established AV rated full service law firm focusing in practice areas that include government, insurance, labor and employment and litigation is seeking an Accounts Receivable Specialist to join their team. The AR Specialist will support the administration of collection activities for assigned clients, practice...

  • Nurse Utilization Management Senior

    1 day ago

    Miami, United States Elevance Health, Inc. Full time

    Job SummaryWe are seeking a highly skilled Senior Registered Nurse to join our Utilization Review and Management team at Elevance Health, Inc. As a key member of our team, you will be responsible for reviewing and managing patient care to ensure optimal outcomes and efficient use of healthcare resources.Key ResponsibilitiesConduct thorough reviews of patient...