RN Case Manager - Per Diem

Company: Holy Cross Hospital
Location: Fort Lauderdale
Posted on: January 14, 2021

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