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RN Case Manager Full Time Days AdventHealth Zephyrhills

Location Address: 7050 Gall Boulevard Zephyrhills, Florida 33541

Top Reasons to Work at AdventHealth Zephyrhills

• FH Zeph/Dade City Named One of America’s Best Hospitals for Heart Care, Orthopedics, Stroke Centers and Patient Safety three years in a row “2017-2019” by the Women’s Choice Award
• Leapfrog Hospital Safety Grade A Spring/Fall 2018
• One of only 35 Hospitals Nationally Named as a Top General Hospital by The Leapfrog Group
• Four Star Recipient for Coronary Interventional Procedures in 2019 by Health grades
• First in Florida to earn Advanced Certification for Total Hip and Total Knee by The Joint Commission

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. 
• Demonstrates knowledge of payer contracts and provides clinical information to payers, in a fiscally responsible manner.
• 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.
• Treats patients and families with respect and dignity.
• Maintains and respects confidentiality of patient/physician/personnel information
• Able to communicate with physician regarding discharge planning needs of the patient.  Assists the physicians and other care givers to facilitate post-hospital care. 
• Assures prompt communication of information required for timely discharge.
• Is knowledgeable of medical necessity criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Maintains current knowledge of resources available within the community, provides resource materials to be patients when needed.  Is able to obtain other resources as needed.
• 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.
• Interacts professionally with patient/family and involves patient/family in the formation of the discharge plan.
• Documents discharge planning in an ongoing manner.   Consistently provides complete and accurate discharge planning notes.
• Is knowledgeable of patient’s financial status, diagnosis and discharge needs.
• 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.

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 must complete all initial admission assessments within 24 hours of inpatient admission and match the patients 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