Conducts thorough and objective assessment of the client's current status, including a situational analysis and functional assessment covering various elements. Facilitates coordination of comprehensive, individualized plan of care, in collaboration with patient, family and interdisciplinary team.
Acts in accordance with legal principles of consent, healthcare proxies, and advanced medical care initiatives. Positively impacts financial outcomes through management of a case plan. Actively seeks alternatives and contingency plans in cases where resources are not available. Performs reviews in QRS utilizing all of the modules (i.e. lab, dx, auth).
Focus on accountability for quality care and cost/benefit to clients consistent with payer, provider, and consumer expectations. Is knowledgeable and up to date on resource availability, service costs, limitations of coverage and budgetary parameters. Is fiscally responsible to the patient, the hospital and outside referrals when carrying out all discharge planning.
Current Registered Nursing license in the state of Florida or
Certification in Utilization Review.
Certification in Case Management is preferred.
Three years recent Clinical UR/Discharge Planning/Quality management knowledge/experience within an acute care facility
Experience with InterQual application
