RN | Utilization Management | PRN
2 weeks ago
OverviewThe RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring that care is provided at the appropriate level of care based on medical necessity. In addition, the Utilization Manager will work towards denial prevention, promote appropriate length of stay, and ensure compliance withstate and federal regulatory requirements. The Utilization Manager will work with payers to support admission, level ofcare, length of stay, and authorizations for services provided. ResponsibilitiesClinical review on all assigned patients performed to document if MCG criteria met in the appropriate setting (Inpatient or Observation). Review includes completion of Important Message from Medicare and Medicare Outpatient Observation Notices as required by Medicare and Medicare Advantage Plans.Application of MCG SI/IS criteria to assure necessity of admission/CSR (including all adults and pediatrics). Effectively summarizes and refers cases not meeting criteria to Physician Advisor.Applies regulatory requirements and policy concerning observation regarding time limitations in observation, physician order for observation, physician conversion order to inpatient, and determining the appropriate diagnostic test setting for outpatient versus inpatient.Collaborates daily with the direct care givers (care coordination, nurses, and physicians, ancillary departments) to coordinate the patient's length of stay, timely utilization, and appropriateness of those resources. Collaborates with care coordination in event of necessary referral cases.Provides documentation review to certify the admission and/or continued length of stay to the third party payers; negotiating for additional days if necessary. All documentation noted in ACM.Tracking of Avoidable Days in ACM by completing the necessary user defined fields of data. Uses this data to address opportunities for improvement.Flags cases for the Risk Manager and Quality Assurance Coordinator regarding adverse events, appropriateness of procedures, and quality of care issues.Enters Medicaid chart data into the eQHS computerized system to obtain appropriate authorization and approval of continued stay days. Also assures timely inputs of Medicaid retro reviews when eligibility is confirmed.Identifies opportunities for improvement in the hospital system processes as well as suspected problems of under or over utilization in inappropriate scheduling of services and bring attention to the Utilization Management Manager. Observes rules of confidentiality specific to the Utilization Management Department (information obtained in files, committee discussions, data security, proper disposal of QA information, etc).All other duties as assigned by department. QualificationsEducation required:Associates in nursingExperience required:3 year acute care nursingExperience preferred:Acute care utilization management Accredited Case Manager (ACM)
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RN | Utilization Management | PRN
2 weeks ago
St Augustine, United States UF Health Full timeOverview The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring that care is provided at the appropriate level of care based on medical necessity....
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RN Utilization Management Evenings
2 weeks ago
St Augustine, United States University of Florida Health Full timeRN Utilization Management Evenings Overview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring...
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St Augustine, United States UF Health Full timeOverview The Case Manager Assistant under the direct supervision of the Registered Nurse Case Manager will perform clerical duties to include but not be limited to: issuance of regulatory letters, monitoring of Sfax for authorizations and denials, transference of Medicare primary insurance information to ACM, obtaining insurance authorizations...
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Utility Operations Manager
4 weeks ago
St. Augustine, Florida, United States Reeves Construction Company Full timeJob SummaryWe are seeking an experienced Utility Foreman to manage the day-to-day utility operations of our construction projects. The successful candidate will have excellent communication skills, a basic knowledge of utilities, and the ability to work safely and follow company policies.Main ResponsibilitiesSupervise various phases of a utility operation,...
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Utility Operations Manager
4 weeks ago
St. Augustine, Florida, United States Upstone Materials Inc. Full timeJob SummaryWe are seeking an experienced Utility Foreman to manage the day-to-day utility operations of our construction projects based out of St. Augustine, FL.Main ResponsibilitiesSupervise various phases of a utility operation, including the installation of storm drainage, water, and sewer utilities.Read and interpret plans to ensure accurate execution of...
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PRN Nurse
2 months ago
St Augustine, United States St. Augustine Youth Services Full timePRN - RN or LPN NURSE: $26 to $30 per hour (SignOn Bonus and evening and weekend bonus) St Augustine Youth services is a well-known and respected organization that has been providing residential therapeutic care to boys for over 30 years. We're looking for a PRN/part time RN/LPN to help support our team. The ideal candidate will have at least 2 years of...
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PRN Nurse
1 month ago
St. Augustine, Florida, United States St. Augustine Youth Services (SAYS) Full timeJob OpportunityWe are seeking a PRN/part-time RN/LPN to join our team at St. Augustine Youth Services (SAYS). As a PRN nurse, you will provide care and support to our youth, working collaboratively with our team to ensure the best possible outcomes.ResponsibilitiesProvide the five functions of care management: planning, assessment, linking and advocacy,...
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Speech Therapist
4 weeks ago
St. Augustine, Florida, United States Westminster Communities of Florida Full timeJob Title: Speech Therapist - Health Center PRNJob Summary:Westminster Communities of Florida is seeking a skilled Speech Therapist to join our Health Center team on a PRN basis. As a member of our Therapy Team, you will provide patient/resident assessment, care planning, direct treatment, and consultation to a general rehab caseload. You will participate in...
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St Augustine, United States UF Health Full timeOverviewThis is a PRN Varied Day Shift position with 10 Hour Shifts. 9am-7:30pmThe Phlebotomist draws blood following established departmental procedures in a safe manner with minimal trauma to patient.: Verifies patient identification by using two patient identifiers: Name, DOB or Medical Record Number. Labels all specimens in front of patient with required...
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Utility Foreman
1 month ago
St. Augustine, Florida, United States Colas Full timeAbout the RoleWe are seeking an experienced Utility Foreman to join our team in St. Augustine, FL. As a key member of our construction team, you will be responsible for managing the day-to-day operations of our utility projects, including supervising personnel, vendors, and subcontractors.Key ResponsibilitiesSupervise the installation of storm drainage,...
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St Augustine, United States UF Health Full timeOverviewThis is a PRN Varied Day Shift position with 10 Hour Shifts. 9am-7:30pm The Phlebotomist draws blood following established departmental procedures in a safe manner with minimal trauma to patient.: Verifies patient identification by using two patient identifiers: Name, DOB or Medical Record Number. Labels all specimens in front of patient with...
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RN Director of Case Management Lead
4 weeks ago
St. Augustine, Florida, United States healthcarerecruitmentpartners Full timeThe RN Director of Case Management has overall responsibility for managing and coordinating Case Management, Social Work, and Clinical Documentation Improvement.Key responsibilities include ensuring staff compliance with organizational policies and external regulatory agencies, as well as coordinating the integration of the department's patient care and...
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Experienced Utility Foreman
5 days ago
St. Augustine, Florida, United States Colas Full timeJob SummaryWe are seeking an experienced Utility Foreman to join our team at Reeves Construction Company, a subsidiary of Colas USA. The successful candidate will be responsible for managing the day-to-day utility operations of our projects, including supervising various phases of utility installation, managing vendors and subcontractors, and ensuring...
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RN | Utilization Management | Evenings
7 days ago
Saint Augustine, FL, United States University of Florida Health Full timeRN | Utilization Management | EveningsOverview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for...
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RN | Utilization Management | Evenings
1 week ago
Saint Augustine, FL, United States University of Florida Health Full timeRN | Utilization Management | EveningsOverview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for...
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RN Case Manager
1 month ago
St Petersburg, United States Empath Health Full timeJob Details RN Case Manager - PRN - Pinellas and Hillsborough County Apply Job ID PRNFI009367 Date posted 10/14/2024 Position Type PRN Coverage area includes the Pinellas and Hillsborough County areas. The (PRN) RN Case Manager: * is responsible for identifying and coordinating patient/family needs and for providing preventative and supportive care to...
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Hospice Nurse RN PRN Weekends
3 months ago
St Petersburg, United States Strong Force Staffing Full timeAbout the job Hospice Nurse RN PRN Weekends Welcome to Strong Force Staffing Where Your Career Catapults Forward! Hey there, career adventurers! At Strong Force Staffing, we're not just a leading Recruitment Process Outsourcing (RPO) firm; we're your career matchmakers! Think of us as your backstage pass to the hottest jobs with our clients. Our mission? To...
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Travel Nurse RN Position
4 weeks ago
St Louis, Missouri, United States PRN Healthcare Full timePRN Healthcare is seeking a skilled travel nurse RN to join their team in a Progressive Care Unit setting.Job DetailsSpecialty: PCU - Progressive Care UnitDiscipline: RNEmployment Type: TravelAs a travel nurse RN with PRN Healthcare, you will have the opportunity to work in a dynamic and supportive environment, providing high-quality patient care and...
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Travel Nurse RN Position
4 weeks ago
St. Louis, United States PRN Healthcare Full timePRN Healthcare is seeking a travel nurse RN for a Med Surg position.Job RequirementsSpecialty: Med SurgDiscipline: RNEmployment Type: TravelPRN Healthcare offers a competitive pay package and a tax-free stipend. Our company culture is strongly backed by faith-based values and activities.About PRN HealthcareOur mission is to create authentic, meaningful...
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Travel Nurse RN Position
4 weeks ago
St Louis, Missouri, United States PRN Healthcare Full timeJob Title: Travel Nurse RN CVORJob Summary:PRN Healthcare is seeking a skilled travel nurse RN CVOR to join our team. As a travel nurse, you will have the opportunity to work in various healthcare settings and gain valuable experience in a dynamic environment.Job Requirements:- Specialty: CVOR- Discipline: RN- Employment Type: TravelBenefits:- Weekly pay-...
