RN Case Manager - Coral Springs (Per diem/ pool, Days)

RN Case Manager - Coral Springs

This position is located in Coral Springs. The RN Case Manager is responsible for planning, assessing, re-assessing, implementing, monitoring, and evaluating the options and services required to meet the healthcare needs of patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and Case Management. The goal is to facilitate quality of patient care, cost-effective utilization and outcome management, communication between patients, families, and members of the health care team, and the expedition of the movement of patients through appropriate levels of care, as well as safe discharge.

The RN Case Manager assists with the identification of appropriate providers and facilities throughout the continuum of care to ensure that resources of both Nicklaus Children's Health System and the patient are used in a timely and cost-effective manner to meet the healthcare needs. Specific duties include coordinating medical DCP needs specific to pediatric patients, screening charts to determine admission and concurrent level of care criteria, collaborating to eliminate barriers of efficient delivery of care, performing admission and concurrent/retro reviews, and communicating with multiple resources and payor entities to identify appropriate vendors for obtaining authorization for ancillary/hospital services.

The RN Case Manager works in collaboration with family, health care team, payors, and providers to achieve appropriate resource management to implement safe discharge plans. They also assist in identifying and reporting variances in utilization of resources and avoidable days/denials, work in collaboration with Appeals Management/Physician Advisor in the appeals process, and participate in utilization management initiatives for improvement.

Qualifications include RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC), 1-3 years of pediatric or adult acute clinical hospital experience, 1-3 years of experience in discharge planning, utilization management, case management, performance improvement, managed care reimbursement, or transition of care, care coordination, home health. Preferred qualifications include a Bachelor of Science in Nursing, professional certification as a Case Manager, or certification in CPHM, CPHQ, CCM, or ACM, and 5 years of Case Management experience.