Work Type: Active - Benefit Eligible and Accrues Time Off Exempt: Yes
Work Schedule: Monday - Friday Work Hours per Biweekly Pay Period: 80
Shift Time: 8:00am-4:30pm Location: Medical Center, US:FL:Lakeland
Summary: Responsible for utilization review, pro-active utilization management, and basic concurrent monitoring of physician documentation. Works collaboratively with the Social Work/Continuity of Care Coordinator and Case Management Team to meet expected program outcomes. Must identify opportunities for and contribute to the improvement of quality, safety and cost, as well as patient, customer, and employee satisfaction.
Detailed responsibilities: * People At The Heart Of All We Do - Fosters an inclusive and engaged environment through teamwork and collaboration. - Ensures patients and families have the best possible experiences across the continuum of care. - Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created. * Safety And Performance Improvement - Behaves in a mindful manner focused on self, patient, visitor, and team safety. - Demonstrates accountability and commitment to quality work. - Participates actively in process improvement and adoption of standard work. * Standard Work Duties: RN UR/Clinical Resource Coordinator - Actively participates in the Case Management function of the hospital. - Attends hospital and unit meetings - Rounds on units with physicians and staff as needed and may include use of mobile workstation - Conducts chart reviews within hospital units as needed and may include us of mobile workstation - Provides education within units and other departments as appropriate related to Utilization Review related matters - Collaborates on-site in the hospital with Case Management and other member of the interdisciplinary team. - Appropriately documents in the medical record and hospital information systems to adequately reflect the utilization and documentation review processes. Maintains patient confidentiality and privacy; adheres to HIPAA standards. - Organizes job functions and work assignments to effectively complete assignments within established time frames. Regularly provides manager with status updates. Tracks program objectives, maintains workload logs. Readily accepts assignment adjustments to meet workload demands. - Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities. - Perform other related duties as assigned. - Provides timely referrals and works with Social Work/Continuity of Care Coordinators to identify patient socioeconomic and care needs and to coordinate delivery of post discharge services including home health, skilled-nursing, durable medical equipment, and community resources/assistance. - Communicates and works collaboratively with physicians, staff and payers to meet expected patient and program outcomes (i.e., to secure authorized lengths of stay and approval for post discharge services). - Collaborates with the Physician Advisor(s) to identify opportunities to improve physician documentation to best describe patients' condition, acuity, and intensity of services. Implements Physician Advisor directives. - Delivers termination of benefits letters in accordance with hospital policy/procedures - Responsible for basic initial, concurrent and retrospective review of patient hospitalization and status to determine medical necessity against payer criteria and hospital protocols/policies. Reviews average of 30 cases per 8 hour shift. - Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives. * Stewardship - Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities. - Knows and adheres to organizational and department policies and procedures.
Education equivalent experience: Essential: * Graduate of an accredited school of nursing. Nonessential: * Graduate of an accredited school of nursing.
Licenses Essential: Registered Nurse in Florida
Certifications Preferred: Advanced certification in UR/Case Management. Experience Essential: Minimum one year experience in an acute care, payer or intermediary setting performing utilization review. Familiar with InterQual and M&R review guidelines. May consider equivalent advanced degree with requisite experience and certification. If STEP or PT Daily and normally scheduled to work less than 40 hours per pay period, must have minimum of one year full time UR experience in acute care hospital setting.
Internal Number: 7303
About Lakeland Regional Health
Lakeland Regional Health is committed to providing patient-focused, health care services while continuing to improve the quality of care to our patients, families, guests and physicians.