Talent.com
Inpatient Nurse Reviewer

Inpatient Nurse Reviewer

DOCTORS HEALTHCARE PLANS, INC.Coral Gables, FL, US
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.filters_job_card.quick_apply
job_description.job_card.job_description

Position Purpose :

  • Works in partnership with physicians, nurse case managers, and other disciplines to ensure the appropriateness for the corresponding level of care utilizing evidence-based criteria.

Key Responsibilities :

  • Uses a collaborative process to plan, assess, re-assess, implement, monitor, and evaluate the options and services required to meet the healthcare needs of the patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and Case Management.
  • Reviews the appropriateness of Severity Index / Intensity of Service for all acute care admissions utilizing evidence-based criteria guidelines within the appropriate time frame.
  • Notifies the Medical Director of all acute care admissions not meeting evidence-based criteria potential / actual denials.
  • Presents case for patients not meeting criteria for medical necessity for the requested level of care / patient status to the Medical Director.
  • Proactively identifies and resolves delays and obstacles for safe discharge.
  • Seeks consultation from appropriate disciplines / departments to expedite care and facilitate safe discharge.
  • Communicates with multiple resources and payors to identify appropriate vendors for obtaining authorization for ancillary / hospital services to facilitate transition to appropriate level of care.
  • Collaborates with family, health care team, payors, and providers to achieve appropriate resource management to implement safe discharge plan of care established by health care team and family.
  • Assists in identifying and reporting variances in utilization of resources, avoidable days / denials.
  • Works in collaboration with Appeals Management / Medical Director in the appeals process.
  • Responsible for the appropriate use of software and applications, and enters case management information accurately and in a timely manner.
  • Adheres to Medicare and Medicaid regulatory guidelines as it pertains to patient admission / safe discharge.
  • Provides after hour safe discharge coverage for all hospital units.

    • Participates in utilization management initiatives / opportunities for improvement through departmental committee assignments.    Qualifications :

  • Registered Nurse, Licensed Practical Nurse or Foreign Medical Graduate.
  • Current and valid license to practice as a Registered Nurse or Licensed Practical Nurse in the State of Florida. 3 years minimum experience in discharge planning, utilization management, or case management.
  • Basic proficiency in Microsoft Word, Excel, and Outlook.
  • Demonstrates commitment to the Partners-in-Caring process and the behavioral expectations in all interactions and in performing all job duties.    Performs duties in a manner to promote quality patient care.
  • Able to communicate effectively both verbally and in writing in a clear, concise, and courteous manner.
  • Fluent in Spanish preferred.
  • Working experience with electronic medical records, and / or discharge planning and case management systems.
  • Able to maintain confidentiality of sensitive information.
  • Able to work in a fast-paced environment and effectively manage and use resources to successfully meet the competing deadlines of a variety of tasks, problems, and projects.
  • Able and available to work a flexible / rotating schedule, including holidays and weekends.

    • Note :

  • This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.    No Third Party Agencies or Submissions Will Be Accepted.    Our company is committed to creating a diverse environment.
  • All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
  • DFWP    Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients.
  • Any and all information may change without notice.
  • We reserve the right to solely determine applicant suitability.
  • By your submission you agree to all terms herein.   Powered by JazzHR
    • serp_jobs.job_alerts.create_a_job

    Nurse Reviewer • Coral Gables, FL, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Patient Access Representative 2 (On-Site) - Lennar

    Patient Access Representative 2 (On-Site) - Lennar

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a facu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Remote Medical Scribe

    Remote Medical Scribe

    Scribe-XFort Lauderdale, FL, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Scribe-X offers unparalleled clinical experience and preparation for medical school.Work from home and gain clinical experience!. Receive extensive paid training that will help you master EMR system...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 3 (On-Site) (H) Lennar

    Patient Access Representative 3 (On-Site) (H) Lennar

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    Patient Access Representative 3.The University of Miami / UHealth Department of Clinical Access has an exciting opportunity for a full-time Patient Access Representative 3 to work at our Lennar locat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Access Representative 2 (On-Site) (H) - Lennar

    Patient Access Representative 2 (On-Site) (H) - Lennar

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    Patient Access Representative 2.The University of Miami / UHealth Department of Clinical Access has an exciting opportunity for a full-time Patient Access Representative 2 to work at our Lennar locat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 2 (On-Site) - Full Time - Bascom Palmer Eye Institute - Lennar Bascom

    Patient Access Representative 2 (On-Site) - Full Time - Bascom Palmer Eye Institute - Lennar Bascom

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a facu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Experienced Bilingual Medical Records Coordinator

    Experienced Bilingual Medical Records Coordinator

    PROMD PRACTICE MANAGEMENT INCMiami, FL, US
    serp_jobs.job_card.full_time
    Experienced Bilingual Medical Records Coordinator or Certified Medical Assistant.Location : Hialeah or South Miami (to be determined). South Florida Perinatal Medicine is a leading healthcare provide...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Access Representative 2 (On-Site) (H)

    Patient Access Representative 2 (On-Site) (H)

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a facu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 1 (On-Site) (H) - UHealth - Plantation

    Patient Access Representative 1 (On-Site) (H) - UHealth - Plantation

    University of MiamiFort Lauderdale, FL, US
    serp_jobs.job_card.full_time
    Patient Access Representative 1.The Patient Access department has an exciting opportunity for a full-time Patient Access Representative 1 to work on-site in Plantation, FL.Serve as Patient Advocate...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 3 (On-Site)

    Patient Access Representative 3 (On-Site)

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click.Workday to use the internal application process. To learn how to apply for a faculty or staff posit...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Specialist

    Patient Access Specialist

    Jupiter Medical CenterMiami, FL, US
    serp_jobs.job_card.full_time
    Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.Outstanding...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 1 (On-Site) (H)

    Patient Access Representative 1 (On-Site) (H)

    University of MiamiFort Lauderdale, FL, US
    serp_jobs.job_card.full_time
    Patient Access Representative 1.The University of Miami / UHealth Department of Clinical Access has an exciting opportunity for a full-time Patient Access Representative 1 to work at our UHealth Plan...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 1 (On-Site) (H) - Lennar

    Patient Access Representative 1 (On-Site) (H) - Lennar

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    Patient Access Representative 1.The University of Miami / UHealth Department of Clinical Access has an exciting opportunity for a full-time Patient Access Representative 1 to work at our Lennar locat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative 2 (On-Site) (U)

    Patient Access Representative 2 (On-Site) (U)

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a facu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    PATIENT ACCESS REGISTRAR

    PATIENT ACCESS REGISTRAR

    Universal Health ServicesFort Lauderdale, FL, US
    serp_jobs.job_card.full_time
    Fort Lauderdale Behavioral Health, a subsidiary of UHS, is a 182-bed treatment facility, conveniently located in beautiful Fort Lauderdale, FL that specializes in the successful treatment of substa...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Access Specialist (On-Site) (H)

    Patient Access Specialist (On-Site) (H)

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a facu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Specialist (On-Site)

    Patient Access Specialist (On-Site)

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click.Workday to use the internal application process. To learn how to apply for a faculty or staff posit...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    MEDICAL SCRIBE

    MEDICAL SCRIBE

    COMMUNITY HEALTH OF SOUTH FLORIDA INCMiami, FL, US
    serp_jobs.job_card.full_time
    The Medical Scribe is responsible for providing real-time, accurate medical documentation and support to physicians.The Scribe will play an integral role in ensuring that we maintain high standards...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Access Specialist UHealth SoL Mia

    Patient Access Specialist UHealth SoL Mia

    University of MiamiMiami, FL, US
    serp_jobs.job_card.full_time
    If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click.Workday to use the internal application process. To learn how to apply for a faculty or staff posit...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30