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Utilization Management Case Manager Rn Jobs in Florida

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Utilization Management Case Manager Rn information

What is the difference between Utilization Management Case Manager Rn vs Utilization Review Nurse?

AspectUtilization Management Case Manager RnUtilization Review Nurse
CredentialsRN license, certification in case management (e.g., CCM)RN license, often with certification in utilization review
Work EnvironmentInsurance companies, healthcare facilities, case management teamsHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing cases, ensuring appropriate utilizationReviewing medical necessity, approving or denying services
Common TasksAssessing patient needs, developing care plans, liaising with providersEvaluating medical records, making utilization decisions, ensuring compliance

The main difference is that the Utilization Management Case Manager Rn focuses on coordinating patient care and managing cases, while the Utilization Review Nurse primarily reviews medical records to approve or deny services. Both roles require RN licensure and related certifications, but their daily responsibilities and work environments differ slightly.

Are utilization management case managers in demand?

Utilization management case managers are in demand due to the growing need for healthcare cost control and efficient patient care coordination. Employers in healthcare organizations, insurance companies, and managed care plans seek professionals with strong clinical knowledge, certification, and experience in utilization review processes. The role offers stable employment opportunities as healthcare systems focus on cost-effective treatment management.

What cities in Florida are hiring for Utilization Management Case Manager Rn jobs?

Cities in Florida with the most Utilization Management Case Manager Rn job openings:

RN Case Manager - Case Management

Melbourne, FL • On-site

HEALTH FIRST CAREERS
See more jobs at HEALTH FIRST CAREERSexternal

Other

Medical, Vision

Re-posted 3 days ago

Job description

Job Requirements
POSITION SUMMARY:
The RN Case Manager is fully engaged in providing quality/no harm, customer service and stewardship by utilizing advanced clinical skills in the assessment, planning, intervention and evaluation of patient care in accordance with Federal Conditions of Participation, State of Florida regulations, and The Joint Commission (TJC) accreditation standards. The RN Case Manager uses sound clinical judgment, working collaboratively with the interdisciplinary team, patient, family, and significant support personnel to achieve optimal clinical outcomes through effective utilization of resources and discharge planning for all hospital admissions.
PRIMARY ACCOUNTABILITIES
  1. Initiates care transition at time of admission, developing and revising individualized discharge plans (as indicated by assessment/reassessment and response to treatment) to meet patient needs during their hospital stay, manage their length of stay, promote efficient utilization of resources, and plan for a safe discharge.
  2. Identifies at-risk populations using approved screening tool and following established referral processes for safe transition to next level care to prevent readmission.
  3. Practices autonomously, consistent with evidence-based standards.
  4. Serves as a case management resource expert for compliance with Medicare IM letter, 3008, 1823 PASSR, and DCF mandatory legal reporting, etc.
  5. Works with the Utilization Department, Physician Advisors, Hospitalists, Emergency and other physicians to ensure appropriate, cost-effective care with the best patient outcomes.
  6. Proactively identifies and either resolves or escalates delays and obstacles to discharge.
  7. Identifies reimbursement factors influencing choice of post-hospital providers and obtains authorizations as required, either directly or in collaboration with the payer's case manager.
  8. Evaluates overall patient daily plan for effectiveness and involves patient and family in formulating plan goals.
  9. Works collaboratively and maintains active communication with physicians, nursing, physician advisor, and other members of the interdisciplinary care team to effect timely, appropriate patient resource management and patient transition.
  10. Demonstrates professional accountability through supporting patient's rights, informed consents and advanced directives.
  11. Initiates appropriate referrals to ethics committee, clinical social worker, risk management or legal services as appropriate.

Work Experience
MINIMUM QUALIFICATIONS
  • Education: Associate Degree in Nursing
  • Licensure: Current, valid State of Florida RN license or endorsement.
  • Certification: Current American Heart Association Basic Life Support Healthcare Provider Completion Card upon hire and maintained.
  • Work Experience: At least three (3) years of clinical experience in an acute care hospital.
  • Knowledge/Skills/Abilities:
  1. Strong analytical, data management and computer skills.
  2. Excellent interpersonal communication and negotiation skills.
  3. Demonstrated critical thinking in resolving or escalating barriers.
  4. Ability to work autonomously and prioritize multiple tasks and role components.
  5. Ability to exercise sound judgment in interactions with physicians, payers, patients and their families.
  6. Flexibility to meet needs in sometimes high demand and stressful situations.

PREFERRED QUALIFICATIONS
  • Education: BSN or Bachelor's Degree in related field.
  • Certification: CCM or ACM.
  • Work Experience: Case Management experience in a acute care hospital.
  • Knowledge/Skills/Abilities:
  1. Knowledge of care transitions, utilization management, case management, performance improvement and managed care reimbursement.
  2. Comprehensive knowledge of continuum-of-care post-acute community resources.

PHYSICAL REQUIREMENTS (Sedentary)
  • Majority of time involves sitting or standing; occasional walking, bending, stooping.
  • Long periods of computer time or at workstation.
  • Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
  • May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
  • Communicating with others to exchange information.
  • Visual acuity and hand-eye coordination to perform tasks.
  • Workspace may vary from open to confined.
  • May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

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