OUR WHY: 5-STAR SERVICE CULTURE

At Physician Partners LLC, it’s our commitment, our passion, and our culture that sets us apart. We don’t just talk the talk - we believe in it and live by it. We are revolutionizing the healthcare industry by focusing on quality, not quantity. Our core value is always to deliver 5-Star Service. And by doing so, we are successfully able to achieve our mission of Better Health.

Physician Partners IPA/MSO aligns payors and providers across all populations with the people, processes, technologies, and information to transition to value-based care and achieve high-quality, cost-effective care with patients and physicians.

We are a preferred partner for driving value-based care adoption and delivering personalized, secure, and seamless healthcare experiences. We take great care of our team, patients, providers, and affiliates. To us, it’s about providing quality care for better outcomes! When our patients win with Better Health, Physician Partners wins.

THE OPPORTUNITY

The HL-UM RN assesses, plans, implements, and monitors a comprehensive plan of care for her/his group of patients. This is done in collaboration with other members of both the internal and external medical team, i.e., physicians, social workers, PT/OT staff, pharmacists, respiratory, dietary, nursing, and case managers. Maintains a focus on the patient's "progression of care" throughout the hospitalization, focusing on:

• Assessing the Right Venue of Care with the Hospitalist: Collaboration with Hospitalist to assess the appropriate level of care for patients in Home/Home Healthcare, Inpatient Rehab (IPR), Skilled Nursing Facility (SNF) or Long Term Acute Care (LTAC) Hospital.
• Coordination of Care: Driving patient care plan through ensuring the daily plan is executed, and management of transitions and post-hospital care.
• Effective Discharge Planning: Prompt, clinically appropriate discharge planning beginning at the time of admission.
• Variance Management: Timely steps in the identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
• Quality Screening: Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.

Essential Functions and Responsibilities:

• Promote the mission, vision, and values of the organization
• All activities associated with this function will be onsite at hospitals located within the Ocala region. These can include Ocala Regional, West Marion, and Advent Health Ocala, in addition to Inpatient Rehab Facility - Encompass. 
• The HL-UM RN assesses, plans, implements and monitors a comprehensive plan of care for patients with any admission criteria primarily but not limited to:
  • COPD/CHF/ESRD/DM/Wounds, 
  • Patients with more than 10 days LOS, and/or 
  • Frequent Flyers
• Communicate and collaborate with the respective Hospital Discharge Planner, Attending Hospitalist, and/or PCP to review and discuss the case
• Visiting patients at the bedside to understand the root cause of hospital admission and working with PCP and Hospitalist to overcome the root cause of admission
• Collaborate with our PPLLC UM Nurses on cases that need attention
  • LTAC/IPR requests
  • INP vs OBS 
    • Address ER patients with “Signs and Symptoms” diagnosis to collaborate with hospitalist groups and verify patient meets MCG/Interqual patient admission criteria
• Establish a discharge plan that is relevant based on the root cause of admission
  • Communication with the PCP of record and/or internal clinical teams
• Discuss advance directives and execute
• Review and discuss with the patient
• Review and discuss the following in detail with the patient:
  • Discharge paperwork
  • Complete Medication review and reconciliation
  • Transportation 
  • Home/Family support 
  • Meals 
  • Specialist appointments/post-discharge follow-ups
  • PCP appointments/post-discharge follow-ups
  • Home health/ PT/OT/ DME
  • COPD/CHF/ESRD/WOUND/DM care education

Qualifications:

• At least 5 years of Case Management experience preferred
• Previous training and demonstrated competence in negotiations, Quality Assurance, and Case Management outcomes.

Special Licenses or Certifications:

• Proof of successful completion of educational requirements for a Nurse as defined by the state of Florida as well as proof of such licensure in good standing.
• Complex Case Management (CCM) certification is a plus.
• Valid Florida Driver’s License and vehicle insurance

Key Attributes:

• Has a contagious and positive work ethic, inspires others, and models the behaviors of our core values and guiding principles
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments
• Is able to work within our Better Health environment by facing tasks and challenges with energy and passion
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals
• Demonstrated ability to handle data with confidentiality
• Demonstrated ability to effectively and clearly present information through the written word or interpretation of data, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well

Skills, Abilities, and Professional Competencies:

• Computer literacy in Google Suite, Microsoft Office products, proprietary Health Management systems, hospital EMRs, and Health Plan portals.
• Excellent relationship management skills.
• Ability to document in Electronic Database systems.
• Demonstrated ability to solve complex, multifaceted, and emotionally charged situations.
• Ability to function with minimal supervision.
• Ability to successfully manage conflicts, negotiating “win-win” solutions.
• Strong organizational, task prioritization skills
• Detail oriented
• Thorough documentation
• Patient advocacy focus
• Empathy

Supervisory Responsibility:

• Hospital Liaison - Utilization Management Nurse will report to the Director of Utilization Management

Work Environment:

• Hospital Liaison - Utilization Management Nurse operates in Ocala with occasional travel to Tampa HQ
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, and fax machines

Physical Demands:

• Ability to drive from facility to facility on a daily basis
• Ability to stand for extended periods of time
• Ability to spend an extended amount of time facing a computer screen.

Position Type/ Expected Hours of Work:

• This is a full-time position and core hours of work and days are Monday to Friday 8:00 a.m. - 5:00 p.m.
• Extended hours to accommodate urgent and emergent tasks will be expected.

Reimbursement:

• Mileage to and from home/work to other locations will be compensated at company rates
• Fees incurred for parking will be compensated with receipts provided 

Travel:

• At least monthly travel to Corporate or Regional Offices may be required for training or meetings.