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Registered Nurse Case Manager Emergency Department Full Time Evenings

Work Hours/Shift
Full time/ Evenings
Florida Hospital Wesley Chapel
Florida Hospital Wesley Chapel has provided faith-based, whole person care to the community since it opened in 2012. Every detail of our 83-bed facility is purposefully designed to create an environment of healing for mind, body and spirit. Our hospital is equipped with state-of-the-art equipment from outpatient services to our surgical suites and inpatient care. In 2013, we also opened a 50,000-square foot Health and Wellness Center that includes an indoor track, group exercise areas, and an aquatics center with a lap pool to help community members achieve optimal health. In August 2015, the hospital began construction on am expansion that will open in December of 2016, significantly increasing the number of inpatient beds, surgical suites, and emergency department rooms.
You will be responsible for
+ Assesses clinical information to participate in the development of patient care plans on a continuum through communication with direct nursing caregivers, physicians, and other members of the health care team.
+ Assesses and make decisions which include age-specific assessment of the patients, and/or patient population served (neonate, child, adult, geriatric).
+ Communicates case objectives to individuals involved in providing care to optimize compliance with the plan of care and intervenes when variances occur in the patient's individualized plan of care.
+ Identifies and directly addresses issues that effects patient care outcomes, collaborates with appropriate providers to prevent recurrence of issues; utilize best practice, evidence based guidelines or monitoring tools in order to develop systems to achieve optimal outcomes for patient and family/caregiver.
+ Establishes networks and referral sources to maximize utilization of available community/regional resources; value the expertise of other team members in the creation of the highest quality care.
+ Provides nursing and discharge planning expertise in collaboration with other health care professionals, to include the emergency room physician(s), Hospitalists, primary care physician and specialists, if required.
+ Acts as an advocate for an individual?s health care needs post ED discharge.
+ Establishes a trusting relationship with patients and families by active listening.
+ Provides a referral base or community-based healthcare provider partnership, and advocacy to gain access to services and resources for patients.
+ Identify patient?s barriers to self-care and the additional services needed at discharge, eg., home health, DME, caregiver support.
+ Provides recommendations for community resources to patients and families including alert systems, community partners, and prescription assistance.
+ Implements skills and intervention processes to include coaching, coordination, education of patient/family, health team members.
+ Understands the physical and psychological characteristics of the disease process in the service specialty and utilizes this knowledge to coordinate resources to meet the needs of the patient?s wellness and functional level.
+ Works with patients and families to assist them in understanding and participating in the development of a transition plan for community-based care; incorporates self- care, and any shared decision making with medical/durable power of attorney designee.
+ Utilizes teach back techniques to reinforce discharge instructions by the emergency department physician or nurse.
+ Assesses post hospital medical, social, and financial needs, working with the patient/family/significant other in obtaining assistance in meeting the needs; completes referrals to Social Services Staff, as needed.
+ Maintains familiarity with laws, regulations, and interpretation of the same as relates to utilization review and discharge planning.
+ Reviews and follows regulations related to HIPAA, Patient Bill of Rights, EMTALA, and Patient Choice.
+ Knowledgeable of resource management, including hospital services and funding, clinical standards and outcomes.
+ Demonstrates the understanding of requirements for pre-certification process by payers; familiar with ICD-10 and DRG coding principles.
+ Acts as liaison between the third-party payers, health care team and patient/family/significant other.
+ Coordinates continuum of care services with third party payers, ensuring the most appropriate cost-effective quality services are provided for patients.
+ Analyzes the clinical assessment data to identify immediate short term and long term patient needs across the continuum, and collaborates with ED physicians and other team members regarding the patient?s severity of presenting signs and symptoms during the final determination of the medical necessity and rationale for either an emergency room discharge or hospitalization.
+ Demonstrates the understanding and ability to execute the role of Case Manager, remaining up to date on changes in regulations, policies and procedures.
+ Understands Medicare reimbursement principles.
+ Working knowledge of Inpatient/Outpatient Medicare procedures, commercial or managed care special contracted payer inpatient vs outpatient procedures.
+ Maintains knowledge and or skill set with current criteria(s) points for assessment of patient?s presenting illness, or, severity of illness and intensity of services necessary for treatment and recovery, eg. Interqual.
+ Maintains knowledge of care delivery and length of stay through collaborative care planning, hospital/ ED protocols, recognized national practice guidelines, including CMS Quality Indicators.
+ Documents effectiveness of case management services to include medical necessity surveillance for hospital admission appropriateness, ED transition/discharge appropriateness; utilizes case management logs, variance analysis theory and PI monitoring.
+ Applies advanced problem-solving techniques in planning, assessing, coordinating, implementing and evaluation of patient care.
+ Understands the case management philosophy and principles of interdisciplinary team management and collaborative practice.
+ Demonstrates the ability to evaluate the effectiveness of case management processes by utilizing the PI process to evaluate patient outcomes.
+ Demonstrates an understanding of the patient?s needs for religious and vocational services.
+ Conducts informal/formal staff education; assists with training of new staff and student(s) preceptorship.
+ Performs other tasks assigned which are within the employee?s capabilities, licensure
+ Performs an admission initial clinical case review and apply utilization review/resource management processes on patients being admitted through the ED; assures medical necessity documentation to include risk stratifications justifying the specific needs for acute care hospitalization; appropriate admission status, and appropriate level of care bed management. Review case management departmental policies and procedures for workflow.
+ Works collaboratively and participates in 1:1 medical necessity appropriate conversations with admitting physician(s) to ensure or improve the overall quality of the patient?s clinical presentation and treatment plan reflects within the documentation from the ED point of entry.
+ Initiates a case management secondary review, when a patient?s medical record does not reflect medical necessity elements in documentation, justifying the need for hospitalization.
+ May perform a medical necessity/transition planning case review on patients prior to discharge to ensure patient?s
What will you need:
+ Minimum ? two (2) years of experience in an acute care hospital required.
+ Minimum required ? Associate of Arts in Nursing or Diploma in Nursing
+ Licensed Registered Nurse in the State of Florida upon hire
+ 2 hours Stroke Education within 6 months or hire date, then 1 hour annually
+ 1 hour Hip and Knee Replacement Education within 6 months of hire date, then annually
+ BS in Nursing (Preferred)
+ Case Management Certification (CCM) (Preferred)
+ Case Management in an acute care setting, or Case Management in a Home Health Care setting; or Case Management for an insurance company (Preferred)
+ Emergency department case management experience (Preferred)
+ American Case Management Association (ACMA) (Preferred)
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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