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Case Manager Utilization Review, Pool Varied Days, BHC (45140)

Company: Broward Health
Location: Fort Lauderdale
Posted on: September 25, 2022

Job Description:

Broward Health is Broward County's largest healthcare services provider and is one of the nation's top public health systems. We are seeking a qualified professional to join our team.


The individual in this position is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

* Utilization Management supporting medical necessity and denial prevention
* Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
* Communication with the Care Coordination team by demonstrating efficient throughput while assuring care is sequenced and at appropriate level of care
* Compliance with state and federal regulatory requirements, TJC accreditation standards and policy
* Education provided to physicians, patients, families and caregivers

The individual's responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, managing concurrent disputes, making appropriate referrals to other departments, collaborating with physicians, office staff and ancillary departments, leading and facilitating Complex Case Review, timely complete and concise documentation in the Case Management documentation system, maintenance of accurate patient demographic and insurance information, identification and documentation of potentially avoidable days, identification and reporting over and underutilization, and other duties as assigned.

Two years' acute hospital Utilization Review experience. BSN preferred. Certified Case Manager (CCM) or (ACM) Accredited Case Manager preferred.

Active Registered Nurse in the state of Florida/multi-state or Foreign Medical Graduate with Utilization Review experience.

BLS, CCM preferred

Must complete MCG education course within 30 days of hire (and at least annually thereafter) and pass. Must complete and demonstrate competency in using the Case Management documentation system within 30 days of hire.

Thank you for your interest in Broward Health. Broward Health is an Equal Opportunity Employer and Affirmative Action procurer of goods and services.

Keywords: Broward Health, Fort Lauderdale , Case Manager Utilization Review, Pool Varied Days, BHC (45140), Executive , Fort Lauderdale, Florida

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