Utilization Review - Registered Nurse RN

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POST DATE 9/13/2016
END DATE 12/24/2016

HCA Healthcare Tampa, FL

Tampa, FL
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Job Code: 26537-3732


No Weekends

Memorial Hospital of Tampa has been providing comprehensive healthcare services for residents of south Tampa and the surrounding community for over 30 years. Recent renovations and the addition of state-of-the-art technology has kept the hospital modernized to provide high-quality medical care, including emergency medicine, diagnostic procedures, surgery, outpatient therapies and acute care for hospitalized patients. With a high caliber medical staff and a team of caring, skilled employees, it s no wonder Memorial Hospital has a long-standing reputation for excellence.

POSITION SUMMARY: Provides ongoing support and expertise through overall evaluation of individual patient. Enhances the quality of patient management and satisfaction to promote continuity of care and cost effectiveness through the integration of case management and utilization review management.

Role Accountabilities Include:

* Works with Discharge Planner and RN to ensure discharge planning process is active and meets the needs of the patient.

* Participates with RN nursing staff in Treatment Planning to ensure plan meets patient's clinical, psychological and discharge needs in collaboration with the attending physician and interdisciplinary team.

* Evaluates the health status of assigned patients by collecting and analyzing patient and family data, and expedites and coordinates the delivery of services to facilitate patient s progression through the healthcare system.

* Performs admission certification screening for patients in accordance with Utilization Plan using ISD criteria, and performs concurrent stay reviews at least every 48 hours for medical necessity using ISD criteria.

* Acts as an educational resource and provides consultation to hospital medical personnel regarding discharge planning process and applicable federal, state and local regulations; identify benefits, implications and limitations of home care as appropriate.

* Monitors and controls the use of healthcare resources to achieve desired patient outcomes, decrease length of stay, and decrease resource utilization. Identifies and documents delays in care and services and reports findings to department director.

* Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems.

* RN with current state licensure, BSN preferred

* Three years of recent nursing experience in acute care setting. Case Management experience preferred

* Certification in Case Management preferred

* Ability to establish and maintain collaborative and effective working relationships

* Demonstrates analytical and critical thinking abilities with pro-active decision-making and negotiation skills

* Demonstrates an ability to perform specific competencies as identified on the Case Management Competency Grid

Last Edited: 07/22/2016