ED Utilization Management Registered Nurse

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

Schedule: Full Time

Shift: Days

Location: 3100 East Fletcher Avenue Tampa, Florida 33613

The community you'll be caring for: Advent Health Division

Advent Health 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.

Advent Health Tampa is home to the renowned Advent Health 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 Advent Health 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 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.
• 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.

• 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,…