Uses skilled intervention, objective and subjective criteria, clinical best practice knowledge and collaboration with the patient, family, physician, and multidisciplinary treatment team to pace care, achieve quality outcomes and negotiate appropriate reimbursement. Assists with the timely and seamless clinical transition of patients through medically appropriate levels of care.
Coordinates and facilitates patient progression throughout the continuum:
a. Collaborate with members of the interdisciplinary team to facilitate care coordination and care delivery. b. Identify and assist with resolution of delays and obstacles to discharge. c. Meets with patients/families to assess needs and develop individualized discharge plan, collaborating and communicating with interdisciplinary team in all phases of the discharge planning process including referrals for services and transfers to other facilities d. Assists with and maintains consensus of discharge plan from patient/family, healthcare team, physician, and payer. Minimum: Current RN license in Florida.
Coordinate and integrate utilization management functions and quality reviews.
a. Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays. b. Utilizes InterQual criteria to ensure approved level of care. c. Identifies at risk populations using approved screening tools and adheres to established reporting procedures. d. Communicates with clinical staff and support personnel to facilitate covered day reimbursement certification for patients e. Demonstrates working knowledge of contractual arrangements and Health System fiscal accountability referred:
Collaborates with all members of the healthcare team and external customers.
a. Interacts with physicians and hospital staff on CM issues to promote timely and efficient patient care and discharge b. Responds to all requests appropriately, accurately, and timely according to department guidelines. c. Refers appropriate patients to Social Work for clinical intervention and complex discharge planning in a timely manner. d. Refers patients and issues to the physician advisor in a timely manner as indicated.
Active Florida RN license required, Certification in Case Management and BSN preferred.
Minimum: One to two years of job-related experience.