RN / Registered Nurse Job in St Petersburg, Florida / Hospital
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Description
Standard Qualifications: West Florida Shared Services HCA West Florida is a comprehensive network of 16 hospitals with 21 ER locations, 14 surgery centers, 21 graduate medical education programs and a complete continuum of specialized health programs and services that meet the healthcare needs of residents and businesses. In 2016, we treated more than 1.2 million patients and provided an economic benefit to the area of more than $2 billion. · 16 hospitals on 18 Campuses · 14 ambulatory surgery centers · an integrated regional lab · a consolidated service center In 2016, our hospitals in west Florida provided care for 686,004 patients through ER visits and 216,927 patient admissions and observations. Our more than 3,301 physicians and 18,811 employees provide the quality foundation for delivering care to our patients safely , effectively and compassionately. Utilization Review RN Provides ongoing support and expertise to the West Florida Division (WFD) facility Case Management (CM) teams by apply appropriate screening criteria for medical necessity per current process, communicating with payers, and documentation of all related activities. MAJOR ROLE RESPONSIBILITIES · Evaluates new admissions and continued stay for medical necessity using approved criteria through the utilization of the electronic medical record. Application of criteria for medical necessity determination and appropriateness of level of care. · Assumes a collaborative role with the interdisciplinary team to make certain the appropriate level of care, patient status and resource utilization is reached. · Interacts effectively and professionally with physicians and hospital staff. · Demonstrates knowledge of regulatory requirements, HCA ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations as it relates to the provision of Utilization Review (UR) services. · Facilitates patient throughput with an ongoing focus on quality and efficiency. · Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems. · Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered. · Identifies patients with the potential for high risk complications and makes appropriate referrals to the Facility CM team acting as an advocate for the individual's healthcare needs. · Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely.
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