Position Requirements

• Florida RN License-active
• Case Management experience 2+ years
• Utilization review experience 2+ years
• Knowledgeable of resident’s financial status, diagnosis and discharge needs.
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• BLS certification through AHA or ARC

Position Purpose

• Acts as a liaison between patient/family and healthcare personnel to ensure necessary care is provided promptly and effectively.
• Relies on experience and judgment to plan and accomplish goals.
• A certain degree of creativity and latitude is required.
• Typically reports to a head of a department/unit. 
• Familiar with standard concepts, practices, and procedures within a particular field.
• Promote the mission, vision, and values of the organization
• Facilitate team meetings that foster interdepartmental collaboration with the patient and their family as deemed necessary, this includes multidisciplinary meetings and Utilization Review/Case Management meetings. Provides input in such meetings 6regarding utilization management and discharge planning.
• Responsible for evaluating and screening potential admissions to the facility when appropriate.
• Communicate daily with admissions personnel regarding admissions and discharges to various units.
• Initiate ongoing communication with the resident and resident’s family to assess discharge needs.
• Communicate with physicians to ascertain their plans for a timely discharge.
• Document discharge planning as an ongoing review.
• Responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
• Cooperate with insurance companies, based on information received.
• Manage and collaborate with the healthcare team on Swing Bed placement and complete MDS documentation as necessary.
• Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system.
• Assist as needed with obtaining referrals, prior authorization for Home Health Care, DME, SNF, acute rehab and appointments.
• Educates physicians and staff regarding appropriate level of care/utilization issues.
• Develop and implement methods, policies and procedures to improve the departments’ efficiency and overall effectiveness.
• Oversight and evaluation of the discharge planner/ utilization review nurse.
• Perform and oversee needs analysis and planning. Work with executive leadership to ensure targets are met for the annual operating plan/financial management.
• Perform other duties as assigned.

 

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Santa Rosa Medical Center, located in Milton, Florida, is more than just a healthcare institution; it's a place where your career can truly flourish. With 129 beds and an unwavering commitment to excellence, we stand at the forefront of healthcare innovation. Our patient care is second to none, driven by cutting-edge technology, pioneering medical procedures, and a team of highly skilled professionals.

We believe that our employees are our greatest asset, and we offer a supportive, collaborative environment where your professional growth is a priority. As an integral part of our thriving community, we hold dear the values of family and community, making Santa Rosa not just a great place to work but a fulfilling one.

Join us at Santa Rosa Medical Center and be part of a team that is shaping the future of healthcare, where your contributions are valued, your career is nurtured, and your job satisfaction is paramount.

 

INDBFH

Experience

Required

• 2 year(s): Utilization review
• 2 year(s): Case Management

Licenses & Certifications

Required

• L-FL-RN License

Behaviors

Required

• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
• Functional Expert: Considered a thought leader on a subject
• Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations

Required

• Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work
• Goal Completion: Inspired to perform well by the completion of tasks
• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization