Utilization Management Nurse, RN, Casual / Part Time, Days (UM, UR)
Location: Wilmington Delaware
Description: Nemours is presently looking of Utilization Management Nurse, RN, Casual / Part Time, Days (UM, UR) right now, this career will be placed in Delaware. More details about this career opportunity please 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 health 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 cr! eate a children's hospital like no other in the region. Upon c! ompletion in June 2014, the hospital will include private patient rooms, a new Pediatric Intensive Care Unit and a new expanded Emergency Department.
Monitors 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, and identifies and proactively addresses potential denials of payment.
Conducts initial clinical reviews within 24 hours of patient admission. All reviews are to follow unit standards as per CM concurrent review guidelines.
Provides concurrent admission, continued stay and retrospective review to insurance company staff as contractually required.
Communicates anticipated length of stay and insurance review results to interdisc! iplinary team. Participates in interdisciplinary rounds as indicated.
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.
Converts observation to admission and conversely, admission to observation status and communicates change to team and others as indicated.
Mediates between physicians and insurance companies to avoid denials by monitoring patient plan of care and intervening as needed to ensure timely completion of care at appropriate level of care.
Facilitates the timely completion of diagnostic tests, procedures, treatment services, consultations and discharge planning activities in collaboration with the social work staff.
Monitors payor authorization for continued stay.
Communicates length-of-stay authorizations and anticipated discharge date to social work staf! f and unit-based team either during patient care unit rounds or other i! nteraction with social worker, unit-based nursing staff and attending MD.
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.
Requirements
Must have an active DE Nursing License.
BSN preferred.
Minimum 5 years job-related experience.
Don’t miss out on important health care news and updates from Nemours â€" connect with us on…
Facebook (Fan Page) | YouTube | Twitter | Flickr
As an equal opportunity employer, Nemours is committed to focusing on the best-qualified applicants for our openings. Career, Employment, Jobs, Opening, Occupation, Compensation, Salary, Hospital, Health Care, Healthcare, Medical, Clinical, Pediatrics, Pediatric, C! hildren, Child, Neonatal,Registered Nurse, RN, BSN, Bachelor's Degree in Nursing, MSN, Master's Degree in Nursing, Case Manager, Utilization Management, UM, Review, UR
- .
If you were eligible to this career, please email us your resume, with salary requirements and a resume to Nemours.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Sat, 27 Jul 2013 18:26:21 GMT
Apply Utilization Management Nurse, RN, Casual / Part Time, Days (UM, UR) Here