As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
Nemours is seeking a Utilization Management Registered Nurse, FULL-TIME, M-F, 8A-5P to join our Nemours Children's Hospital team in Orlando, FL.
Located in Orlando, Fla., Nemours Children’s Hospital is the newest addition to the Nemours integrated healthcare system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region.
Monitoring patient plan of care for timely completion and efficient use of resources by facilitating diagnostic and treatment services, tests, consultations and procedures. Oversees medical necessity 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
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 interdisciplinary team. Participating 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 inpatient admission and conversely, inpatient admission to observation and communicate 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 assure timely completion of care at an appropriate level of care.
Facilitates the timely completion of diagnostic tests, procedures and treatment services, consultations and discharge planning activities in collaboration with the social work staff and Nurse Navigator.
Monitors payor authorization for continued stay.
Communicate length of stay authorizations and anticipated discharge date to social work staff and unit based team either during patient care unit rounds or other interaction 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.
ASN required; BSN preferred.
Current Florida Nursing license in good standing required.
Certified Case Manager (CCM) preferred
Minimum of one year Registered Nurse Utilization Review experience required; Clinical experience within a hospital setting preferred, Pediatric experience preferred.
Valid American Heart BLS upon hire required upon hire
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Internal Number: 29820
Nemours is committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.