RN - Acute Care Manager (Hospital)

2 weeks ago


Fort Lauderdale Florida, United States Holy Cross Hospital Full time
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

 



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