RN Outpatient Case Manager/Delivery System Specialist

1 day ago


Ocoee, Florida, United States Health Central Hospital Full time
Job Summary

This role is designed for a skilled RN to facilitate effective use of outpatient hospital and clinic resources, ensuring quality patient care and medical necessity criteria are met. The RN will work closely with patients, families, physicians, nurses, and other departments to develop comprehensive case management plans, audit documentation, and resolve medical necessity pre- and post-payment issues.

Key Responsibilities
  • Develop Comprehensive Case Management Plans: Assist with creating personalized plans addressing patient/family needs, promoting optimal outcomes in outpatient case management activities.
  • Audit Documentation and Denial Claims: Ensure compliance with documentation requirements, assist in resolving medical necessity pre- and post-payment issues, and identify trends within the outpatient departments.
  • Collaborate with Patients and Staff: Develop collaborative relationships with patients/families, patient business, nursing staff/leadership, physicians, social workers, and ancillary services to facilitate delivery of quality patient care.
  • Conduct Medical Reviews: Perform audits of orders written, review claim denials, and collaborate with physicians to establish medical necessity.
  • Provide Education and Training: Offer ongoing education to physicians and staff regarding medical necessity criteria and reimbursement guidelines.

Requirements:

  • Bachelor's degree in Nursing or higher required (effective January 1, 2020).
  • Maintain current RN license in the state of Florida.
  • Five years' acute care experience or five years' experience in case management, hospital discharge planning, risk management, quality assurance, and/or utilization review.

About Us:

At Health Central Hospital, we strive to provide high-quality patient care while fostering a collaborative environment that promotes excellence and innovation. As an RN on our team, you will have the opportunity to make a meaningful impact in the lives of our patients and their families.

Compensation: $65,000 - $85,000 per year, based on experience and qualifications. Salary Estimate: $75,000 per year.



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