Utilization Management RN ED

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

3100 E FLETCHER AVE

City:

TAMPA

State:

Florida

Postal Code:

33613

Job Description:

Build relationships to promote interdisciplinary collaboration. Other duties as assigned. Provide status assignment recommendations to providers in emergency department setting. Utilize critical thinking and expertise in utilization review regarding medical necessity, patient status, level of care, and regulatory compliance.

Knowledge, Skills, and Abilities:
• Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
• Must demonstrate knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
• Familiarizes self with authorization requirements for assigned payers, based on payer matrix.
• Demonstrates working knowledge and understanding of state and federal guidelines pertinent to utilization management, as well as current procedural terminology (CPT) codes and inpatient-only procedures.
• Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations based on medical necessity indicators, findings, and documentation.
• Ability to navigate and utilize other related software and databases to perform required actions that encompass Utilization Management.
• Demonstrates strong analytical, problem-solving skills and the ability to analyze complex data.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff.
• Excellent interpersonal communication and negotiation skill.
• Strong analytical, data management, and computer skills.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Thorough knowledge of medical admission screening requirements to assist in determining appropriateness of admission, treatment requested, for a variety of conditions, per evidence-based guidelines.
• Knowledge of hospital reimbursement models and trends.
• Previous experience with and working knowledge of medical necessity screening tool.

Education:
• Associate's of Nursing [Required]
• Bachelor's of Nursing [Preferred]

Field of Study:
• in medical related field

Work Experience:
• 3+ years clinical nursing [Required]
• 5+ years clinical nursing in an acute care setting [Preferred]
• Experience working in electronic health records [Preferred]
• Utilization Management or Care Management [Preferred]

Schedule

• Day shift , working 0630-1900, consisting of 3/12s and 1/4hr shift (0630-1030), rotating weekends

Licenses and Certifications:
• Registered Nurse (RN) [Required] AND
• Accredited Case Manager (ACM) [Preferred] OR
• Certified Case Manager (CCM) [Preferred]

Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/msy4mja2

Pay Range:

$32.76 - $57.47

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.