- Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review
- Request face sheet and clinicals from referring/transferring facility.
- Review referral to determine medical necessity of request and if a specialized level of care is needed that cannot be provided at the current/transferring facility.
- Discuss the transfer request with the nurse and/or referring physician to verify medical necessity of transfer.
- Verify insurance information by sending to request to r-
- RN Transfer Coordinator will connect referring physician with the specialist at OH to determine medical necessity and appropriateness of transfer. If accepted, proceed to discussing transfer with an accepting attending physician at OH. If patient is not deemed medically necessary for transfer, advise the referring hospital the transfer will not be accepted.
- Once patient is accepted, the RN Transfer Coordinator will wait for an assigned bed. If during non-emergent transfer center hours, RN Transfer Coordinator will notify Care Management and Nursing of bed assignment. If after hours, the Emergent Transfer Coordinator will notify Care Management and/or Nursing.
- All transfer requests and communications will be documented in Epic.
- RN Transfer Coordinator will send transfer agreements as needed. Transfer Center will facilitate completion of agreements, and a copy of the executed agreement is uploaded in Epic when received.
- Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review
- Request face sheet and clinicals from referring/transferring facility.
- Review referral to determine medical necessity of request and if a specialized level of care is needed that cannot be provided at the current/transferring facility.
- Discuss the transfer request with the nurse and/or referring physician to verify medical necessity of transfer.
- Verify insurance information by sending to request to r-
- RN Transfer Coordinator will connect referring physician with the specialist at OH to determine medical necessity and appropriateness of transfer. If accepted, proceed to discussing transfer with an accepting attending physician at OH. If patient is not deemed medically necessary for transfer, advise the referring hospital the transfer will not be accepted.
- Once patient is accepted, the RN Transfer Coordinator will wait for an assigned bed. If during non-emergent transfer center hours, RN Transfer Coordinator will notify Care Management and Nursing of bed assignment. If after hours, the Emergent Transfer Coordinator will notify Care Management and/or Nursing.
- All transfer requests and communications will be documented in Epic.
- RN Transfer Coordinator will send transfer agreements as needed. Transfer Center will facilitate completion of agreements, and a copy of the executed agreement is uploaded in Epic when received.
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Registered Nurse Care Manager - Orlando, United States - Orlando Health
Description
Registered Nurse Care Manager - Orlando Health
Position Summary
Orlando Health is a 3,200-bed system that includes 15 wholly-owned hospitals and emergency departments; rehabilitation services, cancer institutes, heart institutes, imaging and laboratory services, wound care centers, physician offices for adults and pediatrics, skilled nursing facilities, an in-patient behavioral health facility, home healthcare services in partnership with LHC Group, and urgent care centers in partnership with CareSpot Urgent Care.
Nearly 4,200 physicians, representing more than 80 medical specialties and subspecialties have privileges across the Orlando Health system, which employs nearly 22,000 team members.
Areas of clinical excellence are orthopedics, heart and vascular, cancer care, neurosciences, surgery, pediatric specialties, neonatology, women's health and trauma.
Responsibilitiessupport systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other
relevant information.
o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning
as appropriate through assessment and reassessment and the application of InterQual guidelines.
o Leading and facilitating multi-disciplinary patient care conferences
o Managing concurrent disputes
o Making appropriate referrals to other departments
o Identifying and referring complex patients to Social Work Services
o Communicating with patients and families about the plan of care
o Leading and facilitating Complex Case Review
o Identification and documentation of potentially avoidable days
o Identification and reporting over and underutilization
Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for
Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval.
Adheres to Utilization Management Plan.
Integrates National standards for care management scope of services including:
o Utilization Management supporting medical necessity and denial prevention
o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level
of care
o Education provided to physicians, patients, families, and caregivers.
Communicates appropriately and timely with the interdisciplinary team and third-party payers.
Other Duties:
Education/Training
Graduate of an approved school of nursing.
Licensure/Certification
Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
BLS/Healthcare Provider Certification within 90 days of hire.
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
Education/Training
Graduate of an approved school of nursing.
Licensure/Certification
Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
BLS/Healthcare Provider Certification within 90 days of hire.
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other
relevant information.
o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning
as appropriate through assessment and reassessment and the application of InterQual guidelines.
o Leading and facilitating multi-disciplinary patient care conferences
o Managing concurrent disputes
o Making appropriate referrals to other departments
o Identifying and referring complex patients to Social Work Services
o Communicating with patients and families about the plan of care
o Leading and facilitating Complex Case Review
o Identification and documentation of potentially avoidable days
o Identification and reporting over and underutilization
Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for
Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval.
Adheres to Utilization Management Plan.
Integrates National standards for care management scope of services including:
o Utilization Management supporting medical necessity and denial prevention
o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level
of care
o Education provided to physicians, patients, families, and caregivers.
Communicates appropriately and timely with the interdisciplinary team and third-party payers.
Other Duties:
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