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RN - Acute Care Manager (Hospital)
4 months ago
Holy Cross Hospital in Fort Lauderdale, Florida is a full-service, non-profit Catholic hospital, sponsored by the Sisters of Mercy and a member of Trinity Health.
Job Description*****On-Site Not Remote: Per Diem Open Positions
Perform focused Utilization Review applying criteria such as MCG, InterQual's ISD-A, or payer- specific criteria. Determine level of care and fiscal impact. Provide information to payers to achieve maximum reimbursement. Address over and underutilization of hospital resources concurrently, including issuance of appropriate notices.
*Conducts intermittent chart reviews for all patients admitted to ensure that patients meet level of care for admission and continuing care.
Demonstrates the application of MCG criteria, as an integrated monitor to ensure adequate clinical documentation for appropriate Length of Stay.
*Provides clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure continued stay authorizations.
*Coordinates Physician Advisor referrals when there are concerns regarding meeting level of care criteria (utilizing MCG). Reviews PA referrals with department manager.
*Demonstrates the application of MIDAS utilization for admission reviews and continued stay documentation.
*Demonstrates knowledge of managed care and third party payor regulations including Medicare and Medicaid level of care standards and requirements.
*Participates in hospital and/or department committees or teams as requested or appointed by the department manager
QualificationsJob Requirements:
Education:
- Graduate of an accredited School of nursing is required. BSN and CCM preferred.
Experience & Skills:
- Minimum of two (2) years acute hospital clinical experience is required.
- Recent experience in case management, utilization review, discharge planning, ongoing monitoring and evaluation of patient care delivery process is necessary.
- Must be self-directed, assertive and creative in problem solving, systems planning and patient care management in high volume work environment.
- Ability to work effectively, collaboratively with multi-disciplinary teams in multiple environment is necessary.
Licensure/Certification:
- Florida RN license required
All your information will be kept confidential according to EEO guidelines.
