Utilization Management Nurse, Casual
Location: Wilmington, Delaware
Description: Nemours is hiring Utilization Management Nurse, Casual right now, this occupation will be assigned in Delaware. For detail informations about this occupation opportunity kindly read the description below. Nemours is seeking a casual Utilization Management Nurse to join our Utilization Management team in Wilmington, Delaware.
As one of the nation's premier pediatric heal! th care systems, Nemours provides world-class clinical care in four states - Delaware, Florida, New Jersey and Pennsylvania. Located in Wilmington, Delaware, the Nemours/Alfred I. duPont Hospital for Children offers intensive and acute inpatient and outpatient services covering more than 30 pediatric specialties. Ranked among the nation's best in pediatric specialty care by U.S. News & World Report, this world-renowned teaching hospital has served children from 42 states and 14 nations. Extending the world-class care of the Nemours/Alfred I duPont Hospital, Nemours duPont Pediatrics provides expert care for even more children across the Delaware Valley through community-based physician services and collaborative partnerships with health and hospital systems.
To keep pace with the changing health care environment and build a healthier future for our children, Nemours has embarked on a multi-phase expansion to create a children's hospital like no other in the region.! Upon completion in June 2014, the hospital will include priva! te patient rooms, a new Pediatric Intensive Care Unit, and a new expanded Emergency Department.
Monitoring patient plan of care for timely completion and efficient use of resources by facilitating diagnostic and treatment services, tests, consultations and procedures. Oversees appropriateness of care using pre-established, health industry standards ensuring the appropriate allocation and use of hospital resources. Facilitates patient flow during the inpatient stay, identifies and proactively addresses potential denials of payment.
1. Conducts initial clinical reviews within 24 hours of patient admission. All reviews are to follow unit standards as per CM concurrent review guidelines.
2. Provides concurrent admission, continued stay and retrospective review to insurance company staff as contractually required.
3. Communicates anticipated Length of Stay and insurance review results to interdisciplinary team. Participating in interdisciplina! ry rounds as indicated.
4. Identifies patients who do not meet current patient class criteria and takes action to communicate and change to appropriate level of care as appropriate with attending physician and interdisciplinary team.
5. Converts observation to admission and conversely, admission to observation status and communicate change to team and others as indicated.
6. Mediates between physicians and insurance companies to avoid denials by monitoring patient plan of care and intervening as needed to assure timely completion of care at appropriate level of care.
7. Facilitates the timely completion of diagnostic tests, procedures and treatment services, consultations and discharge planning activities in collaboration with the social work staff
8. Monitors payor authorization for continued stay
9. .Communicates length of stay authorizations and anticipated discharge date to social work staff and unit based team eithe! r during patient care unit rounds or other interaction with social work! er, unit based nursing staff and attending MD
10. Monitors and facilitates correct patient class and accommodation codes via the EMR for every patient.
Work hours: This is a casual position. It will allow for 18 - 19 hours/week. This nurse will work a consistent 10 hours per week and then fill in more hours as needed for vacation coverage and high census.
Must have an active DE Nursing License.
BSN prefer
Minimum 5 years job related experience.
As an equal opportunity employer, Nemours is committed to focusing on the best-qualified applicants for our openings.
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If you were eligible ! to this occupation, please deliver us your resume, with salary requirements and a resume to Nemours.
Interested on this occupation, just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Sat, 27 Jul 2013 09:55:15 GMT
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