Utilization Review Case Manager RN, Central UR, Full Time, Days

Department: Jackson Health System - Central UR

Address: 1611 NW 12 Ave., Miami, FL 33136

Shift details: Full Time, Days 8:00 AM - 4:30 PM, rotating weekends (Remote)

Why Jackson

Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world's top medical providers for all levels of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University of Miami Miller School of Medicine.

Here, the best people come together to deliver Jackson's mission for our diverse communities. Our employees are committed to providing the best CARE by demonstrating compassion, accountability, respect, and expertise in everything we do.

Summary

Case Manager RN is a professional member of the health care team who has 24/7 accountability for the coordination, monitoring and management of patient care resources to promote the most efficient delivery of patient care services at the appropriate level of care while maintaining a single high standard of care delivery to all patients. The Case Manager RN acts as a resource to all levels of staff in defining/educating/implementing and evaluating patient care and nursing practice standards utilizing the nursing process, current concepts/principles of case management/utilization management/disease management, education, quality improvement, clinical practice and health care trends.

Responsibilities

• Assess complex patient care needs/situation/acuity levels obtaining significant data from assessments (physical/functional, mental, psychosocial, environmental, family support, spiritual, cultural, financial, legal).
• Coordinates patient care through out an episodic / continuous course of care for a specific DRG/diagnosis/procedure/population using InterQual, Millikan or other specific criteria and evidence based guidelines.
• Completes electronic documentation for case management activities such as discharge planning, patient throughput, appropriate level of care, communication with physician, nursing and patient / family member. Articulates information pertinent to clinical condition, LOS, discharge delays, outcomes, resource utilization, discharge planning, etc. at team meetings / presentations, patient care rounds, interdisciplinary rounds and to administration, medical director and physician advisors.
• Follows and performs all related unit specific policies and procedures, as detailed on the unit specific competency check-list.
• Utilizes job and unit specific equipment as required. Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
• Performs all other related job duties as assigned.
  
  

Experience

Generally requires 1 to 3 years of related experience.

Preferred Experience

Utilization Review experience, insurance or hospital setting.

Education

Bachelor's degree in Nursing is required. Employees hired prior to June 1, 2022 are grandfathered in for the BSN degree.

Credentials

• Valid, unrestricted Florida RN license is required.
• Case Management certification (CCM or ACM) is preferred.
• Must meet and maintain valid and current all unit specific and organizational skills/competencies, certifications/licensures, as required by regulatory and/or nursing standard of practice for the specialty.
  
  

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.