RN Utilization Management ED

All the benefits and perks you need for you and your family:

Paid Days Off from Day One

Student Loan Repayment Program

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

Shift : Days

Location: 3100 East Fletcher Avenue Tampa, Florida 33613

The community you'll be caring for: AdventHealth Division

AdventHealth Tampa, a faith-based not-for-profit 626-bed tertiary-level acute care hospital located in the uptown district of Tampa, Florida, specializes in advanced cardiovascular medicine, neuroscience and neurology, digestive health, orthopedics, womens services, pediatrics, oncology, endocrinology, bariatrics, wound healing, sleep medicine and general surgery including minimally invasive and robot-assisted procedures. GME programs on the hospital campus currently include general surgery, obstetrics and gynecology, internal medicine and transitional year.

AdventHealth Tampa is home to the renowned AdventHealth Pepin Heart Institute, a recognized leader in cardiovascular disease prevention, diagnosis, treatment and leading-edge research caring for Tampa Bays hearts for over 35 years.

The Kiran C. Patel Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine, advanced surgery and more contributing valuable knowledge that leads to tomorrows cures for conditions such as heart failure, cancer and other diseases.

The ro le you'll contribute:

The role of the Emergency Department 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. This coverage will be required twenty-four hours per day, seven days a week including weekends, holidays and overnight. The Emergency Department 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 Emergency Department 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. The Utilization Management Nurse is accountable for a designated patient caseload and responsible for specific functions within the role including:

Reviewing available patient records pre-admission, providing timely status recommendations to optimize correct patient classification and corresponding payer notifications/authorizations.

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.

The value you'll bring to the team:

Performs pre-admission status recommendation in Emergency Department or elective procedure settings as assigned, to communicate with providers status guidance based on available information.

Leverages clinical experience and critical thinking to provide status assignment recommendations to providers within an abbreviated timeframe.

Maintaining thorough knowledge of payer guidelines, familiarity with payer processes for initiating authorizations, and following through accordingly to prevent loss of reimbursement, including the management of concurrent and pre-bill denials.

Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate management of claims.

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 patients 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.

Qualifications

T he expertise and experiences you'll need to succeed:

Associate Required.

Bachelor's of Science in Nursing or other related BS or BA in addition to Nursing Preferred.

3 years experience. 3 years acute care clinical nursing experience. 2 Utilization Management experience, or equivalent professional experience.

Clinical experience in acute care facility greater than five years Preferred

4 Utilization Management within acute care setting Preferred 2 Experience working in electronic health records of at least two years Preferred

RN - Registered Nurse - State Licensure and/or Compact State Licensure Current and valid license to practice as a Registered Nurse (ADN or BSN) Required

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Case Management

Organization: AdventHealth Tampa

Schedule: Full-time

Shift: 1 - Day

Req ID: 25038077

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.