Registered Nurse (RN) - Case Manager, CVOR
Surgical Care Affiliates
Jacksonville, FL

Case Manager Registered Nurse - Cardiothoracic & Vascular Surgery Center

Overview Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care. As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge: We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business. We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care. We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients. We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines. The new SCA Health represents who we are today and where we are going-and the growing career opportunities for YOU. Responsibilities Functions as the interdisciplinary team coordinator to ensure the timely provision of cost effective quality care. Monitors for quality and type of services delivered to patients, ensuring management within established parameters. Monitors and ensures completeness of all assigned patients in areas of treatment plan, discount or per diem negotiations, precertification concurrent reviews and timely reports. Determines tentative initial discharge plans in conjunction with patient family goals as needed. Insures the quality, timeliness, and confidentiality of medical record documentation and patient interactions in accordance with the hospital's defined policies and procedures.. Functions as a liaison to the payor to manage the financial resources and ensure effective communication regarding the patient's expected treatment process, progress, and discharge plan. Reviews goal with patient's family and third party payor. Appropriately assesses the need for and arranges financial resources for the patient, including federal, state, county, and local programs. Maintains accurate up-to-date documentation in the medical records regarding patient and family contacts, communications and payors and other services performed on behalf of patient and family. Facilitates and coordinates the discharge planning process Assures discharge planning goals are developed and modified at each team conference. Maintains effective communication with patient, family, and payor regarding discharge plan and progress. Coordinates completion of discharge plan by assisting with arrangements for family education, equipment, outpatient therapy, and other services as appropriate for patient discharge level of care. Meets facility goal for referring patients to outpatient services. Functions as a liaison to the referral source, community agent, etc. to facilitate communication regarding the patient care. Demonstrates continued competence in assessing and providing services for individuals based upon age-specific needs utilizing a developmental Displays an understanding of each patient's cognitive, physical, emotional, and chronological maturity in the assessments, treatment, and care undertaken Appropriately modifies approach to the patient based upon patient age utilizing a developmental Provides appropriate interventions related to safety and infection control Completes appropriate financial management responsibilities by completing all billing/patient attendance grids and census sheets according to facility standards. Job Knowledge Functions as the interdisciplinary team coordinator to ensure the timely provision of cost effective quality care. Monitors for quality and type of services delivered to patients, ensuring management within established parameters. Monitors and ensures completeness of all assigned patients in areas of treatment plan, discount or per diem negotiations, precertification concurrent reviews and timely reports. Determines tentative initial discharge plans in conjunction with patient family goals as needed. Insures the quality, timeliness, and confidentiality of medical record documentation and patient interactions in accordance with the hospital's defined policies and procedures. Functions as a liaison to the payor to manage the financial resources and ensure effective communication regarding the patient's expected treatment process, progress, and discharge plan. Reviews goal with patient's family and third party payor. Appropriately assesses the need for and arranges financial resources for the patient, including federal, state, county, and local programs. Maintains accurate up-to-date documentation in the medical records regarding patient and family contacts, communications with payors and other services performed on behalf of patient and family. Facilitates and coordinates the discharge planning process. Assures discharge planning goals are developed and modified at each team conference. Maintains effective communication with patient, family, and payor regarding discharge plan and progress. Coordinates completion of discharge plan by assisting with arrangements for family education, equipment, outpatient therapy, and other services as appropriate for patient discharge level of care. Meets facility goal for referring inpatients to outpatient services. Functions as a liaison to the referral source, community agent, etc. to facilitate communication regarding the patient care. Demonstrates continued competence in assessing and providing services for individuals based upon age-specific needs utilizing a developmental perspective. Displays an understanding of each patient's cognitive, physical, emotional, and chronological maturity in the assessments, treatment, and care undertaken. Appropriately modifies approach to the patient based upon patient age utilizing a developmental perspective. Provides appropriate interventions related to safety and infection control issues. Completes appropriate financial management responsibilities. Completes all billing/patient attendance grids and census sheets according to facility standards. Provides input for needs such as equipment or supply needs. Demonstrates sound cost containment techniques to patient and facility needs. Qualifications Education Graduate of an Accredited School of Nursing with a Bachelor of Science in nursing preferred. Experience At least five years of clinical experience and utilization review/case management experience. Experience in determining medical necessity in accordance with specified guidelines of hospital. Certifications Current RN licensure to practice in the State of Texas. Successful completion of Basic Cardiac Life Support. USD $75,000.00/Yr. USD $85,000.00/Yr. Education Graduate of an Accredited School of Nursing with a Bachelor of Science in nursing preferred. Experience At least five years of clinical experience and utilization review/case management experience. Experience in determining medical necessity in accordance with specified guidelines of hospital. Certifications Current RN licensure to practice in the State of Texas. Successful completion of Basic Cardiac Life Support. Functions as the interdisciplinary team coordinator to ensure the timely provision of cost effective quality care. Monitors for quality and type of services delivered to patients, ensuring management within established parameters. Monitors and ensures completeness of all assigned patients in areas of treatment plan, discount or per diem negotiations, precertification concurrent reviews and timely reports. Determines tentative initial discharge plans in conjunction with patient family goals as needed. Insures the quality, timeliness, and confidentiality of medical record documentation and patient interactions in accordance with the hospital's defined policies and procedures.. Functions as a liaison to the payor to manage the financial resources and ensure effective communication regarding the patient's expected treatment process, progress, and discharge plan. Reviews goal with patient's family and third party payor. Appropriately assesses the need for and arranges financial resources for the patient, including federal, state, county, and local programs. Maintains accurate up-to-date documentation in the medical records regarding patient and family contacts, communications and payors and other services performed on behalf of patient and family. Facilitates and coordinates the discharge planning process Assures discharge planning goals are developed and modified at each team conference. Maintains effective communication with patient, family, and payor regarding discharge plan and progress. Coordinates completion of discharge plan by assisting with arrangements for family education, equipment, outpatient therapy, and other services as appropriate for patient discharge level of care. Meets facility goal for referring patients to outpatient services. Functions as a liaison to the referral source, community agent, etc. to facilitate communication regarding the patient care. Demonstrates continued competence in assessing and providing services for individuals based upon age-specific needs utilizing a developmental Displays an understanding of each patient's cognitive, physical, emotional, and chronological maturity in the assessments, treatment, and care undertaken Appropriately modifies approach to the patient based upon patient age utilizing a developmental Provides appropriate interventions related to safety and infection control Completes appropriate financial management responsibilities by completing all billing/patient attendance grids and census sheets according to facility standards. Job Knowledge Functions as the interdisciplinary team coordinator to ensure the timely provision of cost effective quality care. Monitors for quality and type of services delivered to patients, ensuring management within established parameters. Monitors and ensures completeness of all assigned patients in areas of treatment plan, discount or per diem negotiations, precertification concurrent reviews and timely reports. Determines tentative initial discharge plans in conjunction with patient family goals as needed. Insures the quality, timeliness, and confidentiality of medical record documentation and patient interactions in accordance with the hospital's defined policies and procedures. Functions as a liaison to the payor to manage the financial resources and ensure effective communication regarding the patient's expected treatment process, progress, and discharge plan. Reviews goal with patient's family and third party payor. Appropriately assesses the need for and arranges financial resources for the patient, including federal, state, county, and local programs. Maintains accurate up-to-date documentation in the medical records regarding patient and family contacts, communications with payors and other services performed on behalf of patient and family. Facilitates and coordinates the discharge planning process. Assures discharge planning goals are developed and modified at each team conference. Maintains effective communication with patient, family, and payor regarding discharge plan and progress. Coordinates completion of discharge plan by assisting with arrangements for family education, equipment, outpatient therapy, and other services as appropriate for patient discharge level of care. Meets facility goal for referring inpatients to outpatient services. Functions as a liaison to the referral source, community agent, etc. to facilitate communication regarding the patient care. Demonstrates continued competence in assessing and providing services for individuals based upon age-specific needs utilizing a developmental perspective. Displays an understanding of each patient's cognitive, physical, emotional, and chronological maturity in the assessments, treatment, and care undertaken. Appropriately modifies approach to the patient based upon patient age utilizing a developmental perspective. Provides appropriate interventions related to safety and infection control issues. Completes appropriate financial management responsibilities. Completes all billing/patient attendance grids and census sheets according to facility standards. Provides input for needs such as equipment or supply needs. Demonstrates sound cost containment techniques to patient and facility needs.