Utilization Review Case Manager RN, Utilization Review, Per Diem, Days

Department: Jackson Memorial Hospital - Case Management, Utilization Review

Address: 1611 NW 12th Ave, Miami, Florida, 33136 

Shift details: Per Diem, Day Shift, 8:00 am-4:30 pm (Local remote, available to work during the week, 4 shifts per month)

Why Jackson: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida. We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success. Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals. 

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.

Education

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

Skill

• General Competencies: Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. 
• Ability to communicate effectively in both oral and written form. 
• Ability to handle difficult and stressful situations with professional composure. 
• Ability to understand and follow instructions. 
• Ability to exercise sound and independent judgment. 
• Knowledge and skill in use of job appropriate technology and software applications. 
• Management Competencies: Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources. Skill in monitoring/assessing the performance to make improvements or take corrective action. 
• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. Ability to plan, implement, and evaluate programs. 
• Ability to establish goals and objectives. 
• Ability to recognize, analyze, and solve a variety of problems. 
• Nursing Competencies: Ability to understand, respects and accommodates patients preferences and needs with regards to their individual beliefs, customs and practices. 
• Must have ability to clearly, accurately and effectively provide information to doctors, other nurses, patients, and family members. 
• Must have ability to show compassion, patience and maintain non-judgmental approach to patients, their families as well as other employees and customers. 
• Unit Specific: Must have clinical knowledge, skill and ability to fully and accurately complete all required unit competencies, as indicated in the unit competency check-list. Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources. 
• Skill in monitoring/assessing the performance to make improvements or take corrective action. 
• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. Ability to plan, implement, and evaluate programs. 
• Ability to establish goals and objectives. 
• Ability to recognize, analyze, and solve a variety of problems.

Credentials

• Valid, unrestricted Florida RN license 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.