Chief Radiologist Jobs in Homestead, FL (NOW HIRING)

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Responsibilities will include, but are not limited to:

Identifying inpatient, observation, acute rehabilitation, skilled nursing facility and custodial admissions and discharges by utilizing the following processes:

The Plan's daily census

The hospital's individual Plan admission log (if available)

Inquiring Plan admissions/discharges through the admission/ER department offices

Direct notification by the member's PCP or family member

Contacting the Plan's hospitalist program, if available

Initiates a concurrent review assessment within one working day of admission notification to determine initial and continued length of stay

Identifies admissions that do not meet the requested level of care (i.e. full admission vs. observation for a hospital facility, inappropriate skill level for a SNF, etc.) and contacts the attending physician to further review and to correct to the appropriate level, if indicated and the attending physician concurs

Confirms member demographics are correct with the information in the SHP computer system

All incorrect information will be documented in the designated area in the system and reported to the SHP Enrollment Department

Confirms if a Plan member has a health care surrogate identified, in the event he/she is unable to make decisions for himself/herself and documents this information in the SHP system

Begins identifying discharge planning and transition of care needs, including social needs, for the member with the initial concurrent review

Discharge planning and transition of care begins with the admission and should be completely in place prior to the time of discharge

Early identification of transition of care needs will help to ensure that the member is discharged to the appropriate level of care setting

Participates and updates the Plan's Medical Director, or designee, in completing regular case reviews to ensure the on-going length of stay is appropriate and meets criteria

Works closely with the attending physician, specialists, the facility case management/social services team, facility ancillary staff, the member and/or legal representative, and the PCP in ensuring lines of communication are open and the immediate and discharge needs of the member are being met

Identifies, documents in the SHP computer system, any potential coordination of benefits (COB) associated with this member and the admission

Identifies members who may benefit from care management services and makes appropriate referrals to the Care Management Team, as indicated

Understands the SHP Care Management Model of Care and actively participates as a member of the Interdisciplinary Care Team, as needed

Identifies and reports any potential quality or risk management issues to the appropriate Plan designated associate

Responsible for documenting the following within the authorization in the SHP computer system:

Initial review findings, including but not limited to:

Reason(s) for admission (chief complaint/problem)

Pertinent medical history, if available

Prior physical status, if available

Co-morbidities, if available

Significant examination, laboratory, and radiological findings

All major procedures that have been completed or ordered, with findings, if available

Initial plan of care, including any discharge planning/transition of care needs identified and any identified potential barriers (i.e. member is in a coma and has no legal health care surrogate)

All communication with the attending physician, consultants and ancillary staff

Appropriate level of care for the admission meets criteria (i.e. full admission vs observation status, skilled level of care, etc.) and if criteria is not met, interventions completed to correct to the appropriate status

Approval/denial status and length of stay approved (NOTE: If denied, all required regulatory and Plan P&P's must be followed)

Concurrent review findings, but not limited to:

Significant changes in the members physical and/or mental status

Significant examination, laboratory or radiological findings

Major procedures that have been completed or ordered, with findings, if available

All communication with the attending physician, consultants and ancillary staff

Updated plan of care

Newly identified discharge planning or transition of care needs, including any identified potential barriers

Approved continued length of stay

Upon discharge, the following documentation should be included:

The members physical and mental status upon discharge

Any identified physical problems that occurred while in the facility (i.e. ulcerations, falls/fractures, etc.)

The discharge plan, which should include, but not limited to:

Discharge disposition (i.e. home, home with HHC, SNF, Acute Rehabilitation Facility, etc.) and the name/address of the facility

If discharged home, confirmation of the address and phone number that the member or legal guardian can be reached at

If discharged home with services, documentation of the services (i.e. Nursing, PT, OT, ST, DME) and be specific

Planned PCP/specialist f/u

Documentation that Plan discharge information was provided to the member or legal guardian

All other significant medical information

All appropriate diagnoses and procedure codes, including ICD-9 and CPT, must be initially entered and updated, as indicated

NOTE: For DRG admissions, ICD-9CM coding must be used with ongoing updating of the DRG

All codes/DRG updates must be confirmed prior to closing a case

Registered Nurse or LPN

Current, active licensure to practice within the State of Florida

Concurrent review experience - 2 year minimum experience

Managed Care experience - 1-2 year minimum experience

Experience with Medicaid and Medicare

Practice experience in the areas of ambulatory and hospital care

InterQual Criteria!

Active Florida drivers license

Hours for this Position:

Mon-Fri 8am-5pm

Advantages of this Opportunity: 

Competitive salary $26.00 - $33.00 per hr. 

Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO 

Growth potential 

Fun and positive work environment

Interested in being considered?