RN Care Manager Full Time Days -  AdventHealth Dade City

Location Address: 13100 Fort King Rd, Dade City, FL 33525

Top Reasons to Work at AdventHealth Dade City

• Only hospital in East and Central Pasco to earn Accreditation in Atrial Fibrillation in 2018 by the American College of Cardiology
• Five-Star Recipient for Hip Fracture Treatment in 2019 by Healthgrades
• Earned Get With the Guidelines Stroke Silver Plus TS Quality Achievement Award 2018 by American Heart/Stroke Association

Work Hours/Shift:

Full Time Days  

You Will Be Responsible For:

• Coordinates discharge planning services and act as an effective member of the interdisciplinary team in improving quality, services, and financial aspects of overall patient care management.
• Completes initial utilization reviews within 24 hours of inpatient admission or as required by payer.
• Conduct concurrent reviews as appropriate per payer requirements and the Utilization Management Plan.
• Evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the case load according to Case Management Department Plan, policies and procedures. 
• Participates in discharge planning role by completing initial discharge planning assessments, formulating and implementing an appropriate discharge plan.
• Function as part of a team to coordinate appropriate and safe discharge planning from the newborn to the Geriatric patient.
• Responsible for performing assessments on Medicare, Medicaid and high-risk patients to determine discharge planning needs, always documents assessments.
• Performs all aspects of Case Management in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.
• Communicates daily with appropriate personnel regarding admissions and discharges to various units.
• Initiates ongoing communication with the patient and patient’s; family regarding discharge needs.
• Communicates with family members and caretakers regarding the needs of the patient and anticipated  discharge plans.
• Documents discharge planning in an ongoing manner.   Consistently provides complete and accurate discharge planning notes.
• Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
• Acts on performance improvement issues identified on assigned unit or related to assigned patients.
• Cooperates with review activities of insurance company, based on information received.
• Collaborates with the Patient Financial Services staff and onsite case workers where patients require such assistance.
• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
• Demonstrates an ability to be flexible, organized and function under stressful situations.   Interacts professionally and effectively in all situations with patients, families, staff, and outside vendors.
• Performs timely UR reviews using Interqual criteria as well as clinical documentation.  
• Seeks additional information from the physician as necessary to support admission status.
• Faxes clinical reviews in a timely manner and assures accuracy and receipt of fax.
• Assures discharge plan in place for high risk for readmission to assure patient’s disease management outside of the hospital.
• Additional duties required

What You Will Need:

• Florida RN license Minimum of Diploma or AS in Nursing
• Two (2) years prior work experience in an acute care hospital as a Registered Nurse.
• Experience with electronic patient information systems required.
• Must have excellent interpersonal skills as well as written and oral communication skills.
• Excellent organizational skills and high degree of self-motivation highly desirable.

PREFERRED:

• Knowledge of Interqual, utilization review, and discharge planning regulations preferred.
• Knowledge/experience with DRG and ICD-9 coding preferred.
• Prior experience in a Case Manager or Utilization Management role.
• OR (If Applicable):  Any combination of education, training or experience that provides the knowledge, skills and abilities required to successfully accomplish the assigned duties and responsibilities of the position.
• Experience in Home Healthcare, Hospice, or skilled nursing facilities is a plus
• ACM, CCM, or other Case Management certification preferred

Job Summary:

The Case Manager functions as a member of an organization-wide team promoting excellent overall case management of patients admitted to the hospital in either inpatient or observation status.  The case manager combines their professional knowledge base and experience with critical thinking skills and an organized team approach to meet organizational goals for outcome indicators such as length of stay and readmissions.  The Case Manager must have the professional ability to practice under minimal supervision and perform the following seven essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation, with emphasis on appropriate resource utilization, efficiency, decreasing length of stay and monitoring cost effective health care across the continuum of care.  The Case Manager maintains accountability for facilitating clinical patient progression through a defined plan of care to achieve optimal outcomes.  The Case Manager utilizes professional knowledge to facilitate a physician-specific plan of care, ensure appropriate resource utilization, and coordinate utilization review and approval by a payer.  The Case Manager supports or coordinates discharge planning services and acts as an effective member of an interdisciplinary team in improving quality, service, and financial aspects of overall patient care management.  This position is required to have competence to assess and case manage all age groups as indicated by the license of a Professional Registered Nurse.  The Case Manager will provide care, treatment, and services within the scope of their license, certification, registration, and/or assessed competencies.  Practice will be in accordance with laws and regulations. 

The Case Manager must complete all initial admission assessments within 24 hours of inpatient admission and match the patient’s ongoing needs with the appropriate level and type of medical, health, psychosocial, or social service as they relate across the continuum of care.  The Case Manager evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the case load according to Case Management Department Plan, policies and procedures.  The Case Manager must meet Department expectations to affect practice variations and enhance patient outcomes.  Demonstrates knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner.  Functions in a team approach to coordinate appropriate and safe discharge planning from the newborn to the geriatric patient