Registered Nurse Utilization Review Part Time Weekend Days in Zephyrhills, FL at Florida Hospital Zephyrhills and Dade City

Date Posted: 9/10/2018

Job Snapshot

  • Job Schedule
    Part-Time
  • Job Category
  • Date Posted:
    9/10/2018
  • Job ID:
    18009976
  • Job Function
    Case Management
  • Travel
    No
  • Shift
    1 - Day
  • AHS Zone
    1-Shared Services
  • Organization
    Florida Hospital Zephyrhills and Dade City

Job Description


Description
Work Hours/Shift
Part Time Days
Florida Hospital Zephyrhills
Facility Description
Florida Hospital Zephyrhills has provided faith-based, whole person care to our community for more than 30 years. This means we build trust, create belonging and deliver hope, thereby extending the healing ministry of Christ, when caring for our patients. Our 139-bed facility includes an Accredited Chest Pain Center with PCI, Heart Institute, Primary Stroke Center, emergency department, state-of-the-art operating rooms, Bone & Joint Center, Simpson Breast Health Center and the area’s only Obstetrics Program, The Baby Place, offering family-centered maternity care. Other special services include, a Center for Wound Healing,  CREATION® Health Wellness Center, CREATION® Health Spa, home health, imaging center, cardiopulmonary rehabilitation, and physical, occupational, and speech therapy.
As a member of Adventist Health System, we have received the Gallup Great Workplace Award five years in a row for having one of the most engaged and best performing workforces in the world. We have also achieved HIMSS Level 6 for our electronic medical record adoption.  In addition, Florida Hospital Zephyrhills is a recognized Top Performer on Key Quality Measures by the Joint Commission.  The hospital has received the American Heart Association’s, Get With the Guidelines Heart Failure Gold Plus and the American Stroke Association’s, Get With the Guidelines Stroke Gold Plus quality awards.
Florida Hospital Zephyrhills is located in in East Pasco County, about 50 miles northeast of Tampa. Because it is part of one of the fastest growing counties in the nation, the area has excellent schools and easy access to metropolitan amenities, including international airports, fine dining, professional and collegiate athletics, shopping, amusement parks, arts and theatre. Pasco County is also part of Florida’s Nature Coast, which includes numerous hiking trails, parks, beaches and opportunities for outdoor recreation
You will be responsible for:
  • Responsible for performing utilization reviews on Medicare, Medicaid, Commercial insurances, HMOs, and third party payors.
  • Communicates with physicians regarding utilization review and compliance issues.
  • Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed.  Is able to obtain other resources as needed.
  • Communicates as needed with admissions personnel regarding admissions and discharges to various units.
  • Involved in performance improvement activities in the department as assigned.
  • Cooperates with insurance company requests and provides relevant information to support severity of illness, intensity of service, and admission status.
  • Collaborates with the Managed Care Coordinator,  Denials Coordinator, and other individuals involved in the billing process to assure appropriate UR is performed and that documentation is the record is accurate and appropriate.
  • Actively participates in Denials meetings, ANSB/CCT conference calls and other meetings related to UR practices and as deemed necessary by department director.
  • Identifies improvement opportunities related to Utilization Review and shares these with the other department members to help facilitate overall improvement.
  • Demonstrates an ability to be flexible, organized, and function under stressful situations.
  • Maintains a good working relationship both within the department and with other departments.
  • Consults other departments as appropriate to collaborate on utilization review and performance improvement activities.
  • Documentation meets current standards and policies.
  • Continually maintains and respects confidentiality of patient/physician/personnel information
  • Is effective in optimizing payment reimbursement through ongoing process of accurate and appropriate utilization review practices.
  • Performs other duties and functions as directed and assigned by Department Director.
  • Consistently displays World Class behaviors every day in every situation
Qualifications
What will you need:                                                            
  • Knowledge of clinical nursing process
  • Patient information computer experience
  • Associate degree in Nursing
  • One year of acute care nursing
  • Registered Nurse with active Florida license
  • ACM or CCM (Preferred)
  • Rehab, Restorative, Palliative, Hospice certified a plus (Preferred)
  • Experience as a hospital Case Manager (Preferred)
  • Interqual knowledge and ability to apply accurately and appropriately (Preferred)
  • Has working knowledge of billing requirements for Medicare, Medicaid, HMOs, and private insurance companies. (Preferred)
  • Is knowledgeable of compliance standards for Medicare and Medicaid (Preferred)
  • Experience with Cerner Patient Information system preferred (Preferred)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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