RN Case Manager - Per Diem
Company: Holy Cross Hospital
Location: Fort Lauderdale
Posted on: January 14, 2021
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Job Description:
Position Purpose: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.This position you
will serve as Nurse Case Manager in the Clinical Coordination Unit.
This is a Per Diem position on day shift plus weekends with NO
benefits.Job Description Details:Conducts initial chart reviews for
all patients admitted to inpatient programs to ensure that patients
meet level of care for admission and continuing care. Utilizes MCG
to document level of care appropriateness. Notifies the C3 of MCG
outcomes when patients are not meeting continued inpatient status.
Performs continued-stay reviews as appropriate for the diagnosis,
services provided, and payor standards.Reviews urgent cases
authorized for 1 day within 24 hours of admission. Reviews
concurrent cases and discharge plans in timeframes determined in
the review process with external entitiesApplies MCG criteria to
ensure that the patient meets Observation level of care and will
ensure a timed written order clarifying Observation and the reason
for placing the patient in Observation is in the Medical Record.
Documents reviews in MIDAS+ Concurrent Review Module on all
Observation patients.Responsible for educating and communicating
Physicians regarding appropriate Observation and Inpatient
admission criteria in accordance with MCG criteria, CMS and Managed
Care regulations.Patients receiving Observation services will be
reviewed at least daily to ensure the patient is continuing to meet
Observation level of care. If the patient meets Inpatient criteria,
the Observation Nurse or Clinical Care Coordinator will obtain a
physician order to change the patient's status to Inpatient. If the
patient is meeting discharge criteria or is out of Observation time
and not meeting the Inpatient criteria, the attending physician
will be contacted to secure orders for discharge.Demonstrates the
application of MCG criteria, as an integrated monitor to ensure
adequate clinical documentation for appropriate Length of
Stay.Provides information regarding options for discharge planning
as outlined by payer benefits to the C3.Provides clinical data as
part of the telephonic or electronic review process to external
parties (as required) to ensure continued stay
authorizations.Responds to Insurance Carrier request for clinical
updates within one business day.Coordinates Physician Advisor
referrals when there are concerns regarding meeting level of care
criteria (utilizing MCG). Reviews PA referrals with department
manager.Coordinates appeals with MD's and external entities.
Responsible for generating appeal requests post discharge with
input and review by department manager.Demonstrates the application
of MIDAS utilization for admission reviews and continued stay
documentation.Documents 100% of Admission Reviews, Continued Stay
Reviews and utilizing MIDAS Software.Maintains appropriate tracking
of authorization, denial, appeal and level of care information in
Midas, Meditech and other mechanisms as required.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.
Participates in clinical quality improvement by identifying
problems and/or opportunities for improvement in clinical outcomes
and utilization of resources, concurrent data collection, and
participation of clinical quality improvement.Drives for cost
effective processResponsible for notifying reportable incidents and
generating appropriate payer incident reports.Sends referrals of
post discharge reviews and appeals to E.H.R. Documents in Midas
that referral was sent. Alerts the appropriate denial team of the
referral.Generates the daily census with associated discharges on a
daily basis and sends them to the appropriate external
parties.Minimum QualificationsGraduation from an accredited school
of Professional Nursing is required. BSN and CCM preferred.Must be
an RN.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.Understands computer
applications and is competent in computer fundamentals.Ability to
work effectively, collaboratively with multi-disciplinary teams in
multiple environments is necessary.Trinity Health's Commitment to
Diversity and InclusionTrinity Health employs about 133,000
colleagues at dozens of hospitals and hundreds of health centers in
22 states. Because we serve diverse populations, our colleagues are
trained to recognize the cultural beliefs, values, traditions,
language preferences, and health practices of the communities that
we serve and to apply that knowledge to produce positive health
outcomes. We also recognize that each of us has a different way of
thinking and perceiving our world and that these differences often
lead to innovative solutions.Trinity Health's dedication to
diversity includes a unified workforce (through training and
education, recruitment, retention and development), commitment and
accountability, communication, community partnerships, and supplier
diversity.
Keywords: Holy Cross Hospital, Fort Lauderdale , RN Case Manager - Per Diem, Executive , Fort Lauderdale, Florida
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