Registered Nurse Utilization Management AdventHealth Tampa
Location Address:3100 East Fletcher Avenue Tampa, Florida 33613
*Please attach resume, and certifications to application
Top Reasons to Work at AdventHealth Tampa
AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.
You Will Be Responsible For: Monitor’s admissions and performs initial patient reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuous basis.
Performs pre-admission status recommendation in Emergency Department or elective procedure settings as assigned, to communicate with providers status guidance based on available information.
Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis
Ensures requested clinical information has been communicated as requested. Monitors daily discharge reports to assure all patient stay days are authorized. Follows up with insurance carrier to obtain complete authorization to avoid concurrent or retrospective denials. Communicates with the other departments / team members for resolutions of conflicts between status and authorization.
What You Will Need:
Current and valid license to practice as a Registered Nurse (ADN or BSN) required.
Minimum three years acute care clinical nursing experience required.
Minimum two years Utilization Management experience, or equivalent professional experience.
Excellent interpersonal communication and negotiation skill.
Strong analytical, data management, and computer skills.
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
Registered Nurse Florida license
The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine legitimacy of hospital admission, treatment, and appropriate level of care. The UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations. The UM RN is responsible to document
findings based on department and regulatory standards. When screening criteria does not align with the
physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM RN is responsible for denial avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated patient caseload and responsible for specific functions within the role including:
Facilitating precertification and payor authorization processes as required, ensuring proper authorization has been secured prior to or at the time of discharge for observation and inpatient stay visits to avoid unnecessary denials.
Working in collaboration with facility Care Management to ensure that high quality health care services are provided in a cost-efficient and compliant manner, in line with regulatory standards.
Adhering to all rules and regulations of applicable local, state, and federal agencies and accrediting bodies.
Actively participating in team workflows and accepting responsibility in maintaining relationships.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.
We believe that good health is the cornerstone of progress. We are firm in our resolve to make exemplary health care accessible and affordable to all, dedicated to lowering the high rate of cardiovascular disease, including stroke, in minority populations and committed to advocacy and diversity. We are guided by ethical principles in all transactions and strive for excellence in our training and skills.