Utilization Review Registered Nurse, Case Management, FT, Day Shift Varies
1 month ago
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 excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence.
Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do. At Baptist Health, we positively impact the human experience for patients, employees, and physicians. Our success comes from a culture of quality and dedication that is instilled into every member of the Baptist Health family.
This year, and for 24 years, we've been named one of Fortune's 100 Best Companies to Work For, based on employee feedback. We've also been recognized as one of America's Most Innovative Companies and People Magazine included us in 50 Companies That Care. Based on the U.S. News & World Report Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors.
But really, the reason we're excited to come to work is the people.
Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs. We develop caring relationships with our patients and their families that go beyond just delivering healthcare. After all, we know what it's like to be in their shoes. Many of us have been patients here and have had family members as patients here. We're committed to delivering quality care in the most compassionate way possible because we feel a personal stake in the outcomes. When it comes to caring for people, we're all in.
Boca Raton Regional Hospital is an advanced tertiary medical center with 400 beds and is a recognized leader in Cardiovascular Care, Oncology, Women's Health, Orthopedics, Emergency Medicine and the Neurosciences, all of which offer state-of-the-art diagnostic and imaging capabilities.
Description:This position conducts concurrent retrospective reviews for clinical, financial, resource utilization. Coordinates with Healthcare team to achieve optimal efficient outcomes, decreasing length of stay (LOS) and avoiding delays/denied days. Helps drive change by identifying areas of performance improvement (e.g., day to day workflow, education, process improvements, patient satisfaction). Is accountable for a designated caseload and provides intervention, coordination to decrease avoidable delays/denial of payment resources. Specific functions include: Facilitation of pre-certification and payer authorization processes, screens pre-admission and admission process by using established criteria for all points of entry ,facilitates communication between payers, review agencies and health care team. Identifies delays in treatment or appropriate utilization and serves as a resource, and application of process improvement methodologies in evaluating outcomes of care. Coordinating communication with physicians and identifies opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments Access Management and other members of the healthcare team to ensure timely communication to payers. Estimated salary range for this position is $ $ / year depending on experience.
Qualifications:Degrees: Bachelors Licenses & Certifications: NBCC Certification in Continuity of Care, Advanced ACMA ACM Certification CCMC Case Manager CDMS Certified Disability Management Specialist Registered Nurse ABMCM Certified Managed Care Nurse McKesson Certified Professional in Utilization Management AAMCN Utilization Review Professionals RNCB Certified Rehabilitation Registered Nurse ANCC Nursing Case Management NACCM Care Manager Certified Additional Qualifications: RNs hired prior to 10/1/2017 with an Associate Degree are not required to have a BSN to continue their non-leadership role as an RN, however, they are required to complete the BSN within 5 years of job entry date. 3 years of hospital clinical experience preferred and 2 years of hospital or payor Utilization management review experience required. A Utilization Review or Case Management Certification is required. Excellent written, interpersonal communication and negotiation skills. Strong critical thinking skills and the ability to perform clinical chart review abstract information efficiently. Strong analytical, data management and computer skills. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Current working knowledge of payer and managed care reimbursement preferred. Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. Knowledgeable in local, state, and federal legislation and regulations. Ability to tolerate high volume production standards.
EOE
-
Boca Raton, Florida, United States Baptist Health Boca Raton Regional Hospital Full timeBaptist 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...
-
Boca Raton, Florida, United States Baptist Health South Florida Full timeBaptist 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...
-
Boca Raton, Florida, United States Tenet Healthcare Corporation Full timeJob SummaryThe Registered Nurse Labor and Delivery Part-Time Night Shift position at Tenet Healthcare Corporation is responsible for providing high-quality, safe, and cost-effective nursing care to patients in the labor and delivery department.Key ResponsibilitiesCoordinate and integrate patient care based on individual patient needs and family...
-
Adult Day Center Registered Nurse
2 days ago
Boca Raton, Florida, United States InsideHigherEd Full timeJob SummaryFlorida Atlantic University is seeking an experienced Adult Day Center Registered Nurse to join our team in Boca Raton, FL.Key ResponsibilitiesAssess and evaluate the health of adult day center participants, providing care and treatment for minor illnesses and injuries.Document patient findings and nursing actions in participant charts and other...
-
Real Estate Legal Support Coordinator
6 days ago
Boca Raton, Florida, United States De Novo Review Inc Full timePosition Overview:De Novo Review Inc is seeking a dedicated and proactive Real Estate Legal Support Coordinator to join our dynamic team. This role is essential for ensuring the smooth operation of our legal processes and providing support in various real estate matters.Key Responsibilities:- Full-time position based in a collaborative office environment.-...
-
Field-Based RN Case Manager
6 days ago
Boca Raton, Florida, United States Trustbridge Full timeOverviewCompensation range: $30/hr. - $40/hr. based on experienceUtilize your nursing expertise to create a positive impact.Hospice nurses deliver compassionate end-of-life care, ensuring comfort and enhancing the quality of life for their patients. They primarily operate within collaborative, team-oriented settings that necessitate ongoing communication...
-
Boca Raton, Florida, United States Baptist Health South Florida Full timeBaptist 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...
-
Adult Day Center Nurse
19 hours ago
Boca Raton, Florida, United States Florida Atlantic University Full timeAbout the PositionWe are seeking a skilled and compassionate Registered Nurse to provide high-quality care to our adult day center participants.The successful candidate will be responsible for:Independently assessing and evaluating the health of adult day center participants.Providing care and treatment for minor illnesses and injuries, exercising...
-
Boca Raton, Florida, United States Baptist Health South Florida Full timeBaptist 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...
-
Patient Care Management Associate
6 days ago
Boca Raton, Florida, United States Acadia Healthcare Full timeEMPLOYEE BENEFITS: Acadia Healthcare offers a robust benefits package for our team members. Current offerings include: Competitive hourly wage with additional shift differentials Comprehensive medical, dental, and vision coverage Participation in the Acadia Healthcare 401(k) retirement plan Exceptional training and development programs Opportunities...
-
Boca Raton, Florida, United States Baptist Health South Florida Full timeBaptist 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...
-
Emergency Care Registered Nurse
5 days ago
Boca Raton, Florida, United States Sollis Health Full timeJob OverviewAs a Registered Nurse at Sollis Health, you will deliver exceptional emergency medical services to our patients in various settings, under the guidance of an attending Physician or Physician Assistant. This role is essential in our expanding organization, providing comprehensive care to both adult and pediatric patients, addressing cases...
-
Labor and Delivery Registered Nurse Specialist
3 hours ago
Boca Raton, Florida, United States Clinical Management Consultants Full timeJob Title: Labor and Delivery Registered NurseWe are seeking a dedicated Labor and Delivery Registered Nurse to join our team at Clinical Management Consultants, a leading healthcare consulting firm.Our organization is committed to delivering exceptional maternal and newborn care, and we provide a supportive and collaborative environment where nurses can...
-
Utility Account Specialist
5 days ago
Boca Raton, Florida, United States City of Boca Raton, FL Full timeSalary: $31.59 Hourly Location: Boca Raton, FL Job Type: Full-Time Department: Financial Services Division: Customer Services FLSA: Non-Exempt Job OverviewThe role involves performing skilled clerical tasks related to customer service and maintaining essential records. Responsibilities include ensuring timely billing for utility accounts, processing...
-
Utility Billing Specialist
5 days ago
Boca Raton, Florida, United States City of Boca Raton, FL Full timeSalary: $31.59 Hourly Location: Boca Raton, FL Job Type: Full-Time Job Number: 03931 Department: Financial Services Division: Customer Services FLSA: Non-Exempt Job OverviewIn this role, you will engage in intermediate-level clerical tasks related to customer service and the management of associated records. Your responsibilities will include ensuring timely...
-
Nurse Paralegal Specialist
1 day ago
Boca Raton, Florida, United States Legal Search Solutions, Inc. Full timeJOIN A DYNAMIC PLAINTIFF PERSONAL INJURY LAW FIRM AS A NURSE PARALEGAL.We are seeking a dedicated medical malpractice nurse paralegal to join our team. This full-time position offers an opportunity to work closely with attorneys in a collaborative environment. Key Qualifications:Florida Registered Paralegal (FRP)Completion of an ABA-approved paralegal...
-
Registered Nurse
17 hours ago
Boca Raton, Florida, United States Tenet Healthcare Corporation Full timeJob SummaryThe Registered Nurse (RN) provides high-quality, safe, and cost-effective total nursing care to all patients utilizing the nursing process. The RN assumes responsibility for overall coordination and integration of patient care based on the need of the patient and family members.The RN directs care according to established standards of safety, risk...
-
Emergency Care Registered Nurse
10 hours ago
Boca Raton, Florida, United States Sollis Health Full timeJob OverviewAs a Registered Nurse at Sollis Health, you will deliver exceptional emergency medical services to our patients within our clinics, under the guidance of an attending Physician or Physician Assistant. This role is crucial in our expanding organization, ensuring seamless medical care for both adult and pediatric patients in situations typically...
-
Boca Raton, Florida, United States Baptist Health South Florida Full timeBaptist Health has a commitment to strengthening the compassionate care we provide. With the addition of Boca Raton Regional Hospital, Baptist Health is able to provide the Palm Beach community expanded access to healthcare services.Boca Raton Regional Hospital is an advanced tertiary medical center with 400 beds and is a recognized leader in Cardiovascular...
-
Nurse Paralegal Specialist
6 days ago
Boca Raton, Florida, United States Legal Search Solutions, Inc. Full timeJOIN A LEADING PLAINTIFF PERSONAL INJURY FIRM AS A NURSE PARALEGAL.Legal Search Solutions, Inc. is seeking a dedicated and skilled medical malpractice nurse paralegal to join our dynamic team. This full-time position requires on-site collaboration in a professional environment.Qualifications:Florida Registered Paralegal (FRP)Completion of an ABA-approved...
