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RN Case Manager Gainesville

RN Case Manager

Full Time • Gainesville
Replies within 24 hours
Benefits:
  • 401(k)
  • 401(k) matching
  • Health insurance
Job Summary and Qualifications
We are seeking a dynamic Case Management RN to join our team. The RN Case Manager facilitates the interdisciplinary plan of care with a focus on evaluating the appropriateness of medical necessity, admission status, level of care, and discharge planning. Coordinates activities that promote quality outcomes and patient throughput. Identifies potential barriers to patient throughput and quality outcomes and facilitates appropriate discharge plans
 WHAT YOU WILL DO IN THIS ROLE: 
  • Conducts initial and ongoing assessment of each individual patient with respect to clinical condition, level of care, and plan of care. 
  • Reviews admission, pre-op orders for all components necessary for preadmission, admission process. 
  • Assist the physician offices in obtaining necessary assessments prior to surgery, procedures, and/or admission. 
  • Includes patient and family in care facilitation and education activities.
  • Assist in the development and implementation of critical pathways. 
  • Utilizes computer support and physician advisor to determine potential outliers (length of stay and changes in condition) in continued hospital stay. 
  • Communicates the benefits and changes in the various benefit plans, both in the terms of health management and financial implications to physicians, , and patients and families as appropriate. 
  • Assists in management of payor denials; issues hospital-initiated notices of non-coverage (HINN’s) 
  • Distinguishes between the levels of care available and interacts with the various benefit plans and their delivery systems to coordinate this care across the continuum. 
  • Defines desired clinical outcomes, sets target dates, and establishes a plan for required services and care, addressing all needs (i.e., physical, psycho-social, financial).  
  • Participates in IDT rounds, 
  • Conducts utilization review, evaluates clinical information, and communicates findings to physicians and payors on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual agreements. 
  • Submits clinical information to insurance companies to ensure all days are authorized and notifies director of continued stay denials. 
  • Applies decision support criteria (e.g. Interqual) appropriately. 
  • Maintains accurate, up-to-date documentation in MIDAS. 
  • Is cross-trained to function in any of the assigned Case Manager areas.
  • Promotes close alignment with medical and ancillary staff to facilitate appropriate patient care delivery, including alternative level of care opportunities. 
  • Completes required documentation for transfer to next level of care. Coordinates with physician for optimal information related throughout the continuum. 
  • Assists with patient/family/significant other’s learning needs, abilities and readiness to learn. Identifies barriers to learning, such as language or culture. Integrates this information into the patient’s plan of care. 
  • Identifies and documents patient/family/SO’s education needs in collaboration with other disciplines and implements an on-going education relevant to these needs. 
  • Documents patient teaching on appropriate teaching tool for each teaching episode. 
  • Ensures patient/family/SO understand discharge instructions
 
 
Requirements: 
 
·         Looking for Recent (within the last year) experienced acute care Case Manager experience (If candidates do not have case manager experience, they would consider someone that has 2-3 years of ICU experience or strong Med-Surg experience)

·         Would also consider someone that has case management experience in a LTAC facility

·         Must have good critical thinking skills. They need to know and understand the medical needs for patients

·         Certification in Case Management, Nursing or Utilization Review is preferred 

·         Florida RN license and/or approved multistate RN license required. Compact license holders have 60 days to obtain the Florida license after relocation.

·         BLS-AHA Provider issued card required within 30 days of start3 years of RN experience in an acute care setting is required 

·         Graduate of an accredited school of nursing as an RN. BSN preferred.
Compensation: $32.91 - $45.25 per hour




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