RN Case Manager-Utilization and Quality Assurance-Weston Hospital
Company: CC Florida - Weston
Location: Fort Lauderdale
Posted on: December 5, 2019
Monitors patient outcomes, optimizing resource utilization and
implementing continuing care plans to meet patients' post-discharge
needs. Works in collaboration with other members of the health care
team and external agencies to facilitate efficient patient
treatment along the continuum of care.
- Monitors patient outcomes, optimizing resource utilization and
implementing continuing care plans to meet patients' post-discharge
- Reviews patients one business day after admission to determine
medical necessity and appropriateness referencing InterQual
Criteria severity of illness and intensity of service for admission
in an acute care setting and reassesses cases at a minimum of every
48 hours for and continued stay referencing InterQual criteria
intensity of service in an acute care setting.
- Utilizes chart review, electronic medical record,
patient/family interviews, and interdisciplinary team as
- Organizes, plans and prioritizes caseload to optimize care
coordination; provides intense case management for patients with
high risk factors.
- Evaluates discharge planning needs on admission review.
Collaborates with patient/family, physicians, nurses, ancillary
personnel and external agencies to develop safe, individualized,
and appropriate continuing care plans.
- Obtains consent from patients for continuing care providers;
initiates timely referrals, discharges, and transportation
- Ensures appropriate information is provided to anyone
responsible for continuing care support.
- Identifies appropriate hospice candidates and communicates with
physician regarding options.
- Reviews observation patients each day to determine appropriate
level of care and patient status; confers with Admitting and
Business Office departments regarding authorization issues as
- Evaluates use and scheduling of hospital resources and
intervenes to prevent over/under utilization.
- Identifies opportunities to prevent avoidable days and reduce
length of stay.
- Participates in development of interdisciplinary care plans and
documentation of patient education.
- Identifies educational needs of patients, families and staff
and takes appropriate actions; assesses readiness for understanding
and assuming responsibility for ongoing care as needed.
- Identifies avoidable hospital days and confers with director
- Facilitates multidisciplinary communication to maintain
ongoing, positive relationships with healthcare team, patients,
families, payers/TPA and community providers; functions as a
resource to all customers to optimize care coordination and
resource utilization Initiates and leads team conferences to
achieve consensus regarding continuing care plans.
- Establishes positive rapport with patients and families;
supports decision-making and advocates for patient to ensure
advantageous use of benefits.
- Utilizes knowledge of legal issues, COBRA regulations and
regulatory agency requirements; issues notices of non-coverage,
important message per CMS guidelines when necessary. Initiates and
completes level 1 PASRR screen for all patients going to sniff
level of care upon discharge.
- Makes appropriate referrals to Social Worker.
- Provides timely and thorough review to insurance
- Documents assessments, interventions, patient progress,
education, referrals and insurance information in CM progress notes
in a timely, accurate manner, as per policy.
- Ensures the LPN has the information necessary for completion of
the nursing process.
- Other duties as assigned.
- Effective August 1, 2013: BSN required upon hire or within 3
years of hire for external hires and internal hires moving from a
non-RN licensed role to an RN licensed role.
- State licensure as Registered Nurse (RN).
Complexity of Work:
- All employees are expected to meet the standards of performance
outlined in the Organizational-Wide Competencies listed below as
applied to the position:
- World Class Service Orientation: Includes attitude, behavior,
interpersonal skill, and problem solving that enable an employee to
respond to internal and external customer needs and expectations in
a positive manner.
- Adaptability: Includes teamwork and flexibility needed to
fulfill job responsibilities including adapting to changes in work
environment and accepting supervisory feedback.
- Efficiency and Effectiveness: Includes quantity and quality of
desired work, as well as organization skills necessary to perform
- Essential Job Requirements: Includes adherence to all relevant
policies, procedures, and guidelines affecting the work
environment, including maintenance of required competencies and
- Supervisory Responsibilities (if applicable): Includes overall
accountability for assigned work group relative to operational
goals, personnel requirements, and budgetary constraints.
- Note: The above stated duties are intended to outline those
functions typically performed by individuals assigned to this
classification. This description of duties is not intended to be
all inclusive nor to limit the discretionary authority of
supervisors to assign other tasks of similar nature or level of
- Effective verbal, written and computer skills.
- 3-5 years clinical nursing and 2 years hospital case management
- Working knowledge of InterQual Acute Care guidelines.
Personal Protective Equipment:
- Follows Standard Precautions using personal protective
equipment as required for procedures.
The policy of Cleveland Clinic and its system hospitals (Cleveland
Clinic) is to provide equal opportunity to all of our employees and
applicants for employment in our tobacco free and drug free
environment. All offers of employment are followed by testing for
controlled substance and nicotine. Job offers will be rescinded for
candidates for employment who test positive for nicotine.
Candidates for employment who are impacted by Cleveland Clinic's
Smoking Policy will be permitted to reapply for open positions
after 90 days. Decisions concerning employment, transfers and
promotions are made upon the basis of the best qualified candidate
without regard to color, race, religion, national origin, age, sex,
sexual orientation, marital status, ancestry, status as a disabled
or Vietnam era veteran or any other characteristic protected by
law. Information provided on this application may be shared with
any Cleveland Clinic facility.
Cleveland Clinic is pleased to be an equal employment employer:
Women/Minorities/Veterans/Individuals with Disabilities Associated
topics: cardiothoracic, coronary, domiciliary, hospice, intensive,
maternal, nurse clinical, psychiatric, staff nurse, tcu
Keywords: CC Florida - Weston, Miami , RN Case Manager-Utilization and Quality Assurance-Weston Hospital, Healthcare , Fort Lauderdale, Florida
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