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RN / Registered Nurse Job in St Petersburg, Florida / Hospital |
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Description Standard Qualifications: HCA West Florida is a comprehensive network of hospitals, outpatient surgery and diagnostic imaging facilities, physician practices, medical education and training programs and a complete continuum of specialized health programs and services that meet the healthcare needs of residents and businesses in West Florida communities. In 2015, we treated more than 1.2 million patients. Our parent company, HCA, is the nation's leading provider of healthcare services. HCA West Florida affiliated facilities include, 16 hospitals on 18 Campuses, 14 ambulatory surgery centers, diagnostic imaging facilities and occupational health sites, an integrated regional lab, and a consolidated service center. The Division UR Lead supports the WFD Case Management departments in admission/concurrent reviews adhering to medical necessity and Corporate Compliance guidelines. This virtual role reviews patient admissions and concurrent stays using hospital software tool and other information sources and integrates patient clinical data with the appropriate selection of Medical Necessity Criteria. The CM will expedite timely response on cases requiring external physician advisor reviews and/or follow up of cases with status determination after normal business hours. The CM will be responsible to contact the payers and documentation of the authorized days in conjunction with available support staff. As reviews are completed, if issues related to conditions not clearly documented as present on admission (POA) placing risk for hospital acquired conditions (HAC) will be communicated back to the hospitals (CDI, CM and Quality) for timely intervention. In addition, patients that require special needs, such as social work intervention will be referred to the hospital team. This role will also involve becoming a subject matter expert in Medical Necessity criteria and Utilization Review. As such travel may be involved to the hospitals as needed for training. * Some information such as the email and phone number are hidden unless you are registered and logged-in
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