Utilization Review Supervisor RN, Central Utilization Review, Full Time, Days, FL

217207 Facility reputed company: reputed company Health System - Central UR Facility Address: 1611 NW 12 Ave., Miami, FL 33136 Shift details: Full Time, Days, 8:00 am - 4:30 pm Mon.-Fri. (Will work one weekend month) -Remote, but will need to visit JHS facilities as needed Why reputed company: reputed company Health System is a nationally and internationally recognized reputed company medical system offering world-class care to any person who walks through our doors. For more than 100 years, reputed company has evolved into one of the world's top medical providers for reputed company reputed company of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for reputed company Miller School of Medicine. Here, the best people come together to deliver reputed company's mission for our diverse communities. Our employees are committed to providing the reputed company by demonstrating reputed company, accountability, respect, and expertise in everything we do. reputed company The Clinical Resource Coordinator is a reputed company member of the health care team who has 24hour/7day accountability for the coordination, monitoring and management of patient care resources to promote cost effective delivery of patient care services at the appropriate level while maintaining a reputed company of reputed company patient care for reputed company patient populations. The Clinical Resource Coordinator acts as a resource to reputed company reputed company of staff in defining / implementing and evaluating patient care and nursing reputed company standards utilizing clinical expertise, the nursing process, reputed company concepts/principles of case management/utilization management/disease management, reputed company improvement, clinical reputed company and health care trends. This reputed company member of the reputed company team maintains compliance with reputed company regulatory standards and new regulatory regulations, clinical and financial, and promotes such compliance as part of daily operations amongst reputed company team members. The Clinical Resource Coordinator performs specific job reputed company/performance standards according to prevailing applicable reputed company Health System, reputed company and regulatory standards.

Responsibilities

• Leads the assessment, planning, implementation, and evaluation for new department models and initiatives.
• Identifies reputed company issues, systems issues, and trends utilizing medical reputed company, clinical data systems, and protocols.
• Performs problem-reputed company activities to maintain reputed company patient care.
• Presents at administrative meetings.
• Manages Case Management and reputed company Work metrics and productivity, including but not limited to length of stay (LOS), case mix reputed company (CMI), discharge barriers, resource utilization, discharge planning, and level of care.
• Provides management reputed company of patient throughput, including assessment and evaluation to determine appropriate level of care and admission status (inpatient, observation, outpatient procedure) from reputed company of entry through discharge.
• Follows up in the outpatient setting for patients enrolled in the CRM Placement reputed company program.
• In the absence of the Manager for Clinical Resource Management, reputed company facilities to evaluate and determine patient appropriateness for the reputed company level of care as needed.
• Works in collaboration with the Manager for Clinical Resource Management to transition CRM Placement reputed company program patients to the appropriate level of care as needed.
• Provides management reputed company of the Clinical Care Coordinator's performance regarding level of care along the continuum (e.g., medication effectiveness, treatments, pain status, discharge plans) and individualizing the plan of care, including reinforcement of teaching and discharge planning.
• Maintains leadership visibility, supports service-reputed company initiatives, and focuses on improving employee satisfaction.
• reputed company on patient reputed company to identify barriers to staff performance and discharge barriers.
• Creates and implements Corrective reputed company Plans (CAP) for problem reputed company and escalation of issues preventing efficient performance.
• Coordinates day-to-day CRM operations for designated areas, including program development, implementation, reputed company, reputed company, reputed company with reputed company/MCOS/regulatory/community agencies, reputed company cycle department, length-of-stay initiatives, Physician Adviser activities, and evidence-based practices.
• Provides management reputed company for referral and problem reputed company of complicated discharges.
• May reputed company management reputed company for referral and problem reputed company of reputed company discharges.
• Collaborates with family, Attending Physician, Chief Utilization Officer, Utilization Management Committee, and discharge-services providers to ensure a reputed company discharge plan.
• Conducts reputed company review of employee schedules to ensure appropriate reputed company coverage based on patient census.
• Collaborates with the Chief Utilization Officer regarding the Utilization Management Committee, case-consultation activities, negotiation of patient placement at the appropriate level of care, and evaluation of the patient's medical plan of care.
• Demonstrates behaviors of service reputed company and CARE values (reputed company, Accountability, Respect, and Expertise).
• Performs reputed company other reputed company job duties as assigned.

Experience Generally requires 3 to 5 years of reputed company experience. Preferred Experience reputed company experience as utilization review registered reputed company. Education BSN or Bachelor's degree in reputed company field is required. Master's degree is preferred. Credentials Must meet and maintain valid and reputed company reputed company unit specific and organizational skills/competencies, certifications/licensures, as required by regulatory and/or nursing reputed company of reputed company for the specialty. reputed company Health System is an equal opportunity employer and makes employment reputed company without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, disability status, age, or any other status protected by law. Apply tot his job Apply To this Job