Utilization Review Registered Nurse, Care Coordination, Bethesda East, FT, 01P-11:30P Local REMOTE
Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.
What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients’ shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we’re all in.
Description
Increases patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum while maintaining regularity compliance. The role Integrates, coordinates care facilitation throughput while working in partnership with the healthcare team. Is accountable for prioritizing, reviewing cases to determine the appropriateness of pre-admission, admission utilizing payer established criteria Assisting in identifying appropriate patient status and level of care. Identify readmissions managing per policy. Identify possible inappropriate hospitalizations and collaborate with the healthcare team to facilitate alternate Level of Care. Assist in identifying physician and staff documentation opportunities to support Quality and Pay for Performance indicators. Estimated salary range for this position is $73860.80 - $96019.04 / year depending on experience.
Qualifications
Degrees:
• Associates.
Licenses & Certifications
• ACMA ACM Certification.
• CDMS Certified Disability Management Specialist.
• ACMA Case Management Administrator Certification.
• NACCM Care Manager Certified.
• ABMCM Certified Managed Care Nurse.
• RNCB Certified Rehabilitation Registered Nurse.
• ANCC Nursing Case Management.
• NBCC Certification in Continuity of Care, Advanced.
• Registered Nurse.
• CCMC Case Manager.
Additional Qualifications
• RNs hired prior to 10/1/2017 with an Associate Degree are not required to have a BSN to continue their non-leadership role as an RN, however, they are required to complete the BSN within 3 years of job entry date.
• A Case Management Certification required within 12 months of hire.
• 3 years of hospital clinical experience with a minimum of 1-3 years of hospital or payor Case management or Utilization management review experience preferred.
• Excellent interpersonal communication and negotiation skills.
• Strong analytical, data management and computer skills.
• Current working knowledge of discharge planning, utilization management, case management and performance improvement preferred.
• Understanding of pre-acute and post-acute venues of care and post-community resources preferred.
• Strong organizational and time management skills.
• Ability to work independently and exercise sound judgment.
• Ability to prioritize and manage multiple high-risk, complex patients.
• Ability to work with multiple members of a care team and maintain positive working relationships.
• Demonstrate the ability to solve problems in a fast-paced environment.
Minimum Required Experience
• BSN Required
• 3 Years of acute care experience required
• 1 year of Utilization Review experience required
EOE, including disability/vets
Apply Now
Apply Now
What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients’ shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we’re all in.
Description
Increases patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum while maintaining regularity compliance. The role Integrates, coordinates care facilitation throughput while working in partnership with the healthcare team. Is accountable for prioritizing, reviewing cases to determine the appropriateness of pre-admission, admission utilizing payer established criteria Assisting in identifying appropriate patient status and level of care. Identify readmissions managing per policy. Identify possible inappropriate hospitalizations and collaborate with the healthcare team to facilitate alternate Level of Care. Assist in identifying physician and staff documentation opportunities to support Quality and Pay for Performance indicators. Estimated salary range for this position is $73860.80 - $96019.04 / year depending on experience.
Qualifications
Degrees:
• Associates.
Licenses & Certifications
• ACMA ACM Certification.
• CDMS Certified Disability Management Specialist.
• ACMA Case Management Administrator Certification.
• NACCM Care Manager Certified.
• ABMCM Certified Managed Care Nurse.
• RNCB Certified Rehabilitation Registered Nurse.
• ANCC Nursing Case Management.
• NBCC Certification in Continuity of Care, Advanced.
• Registered Nurse.
• CCMC Case Manager.
Additional Qualifications
• RNs hired prior to 10/1/2017 with an Associate Degree are not required to have a BSN to continue their non-leadership role as an RN, however, they are required to complete the BSN within 3 years of job entry date.
• A Case Management Certification required within 12 months of hire.
• 3 years of hospital clinical experience with a minimum of 1-3 years of hospital or payor Case management or Utilization management review experience preferred.
• Excellent interpersonal communication and negotiation skills.
• Strong analytical, data management and computer skills.
• Current working knowledge of discharge planning, utilization management, case management and performance improvement preferred.
• Understanding of pre-acute and post-acute venues of care and post-community resources preferred.
• Strong organizational and time management skills.
• Ability to work independently and exercise sound judgment.
• Ability to prioritize and manage multiple high-risk, complex patients.
• Ability to work with multiple members of a care team and maintain positive working relationships.
• Demonstrate the ability to solve problems in a fast-paced environment.
Minimum Required Experience
• BSN Required
• 3 Years of acute care experience required
• 1 year of Utilization Review experience required
EOE, including disability/vets
Apply Now
Apply Now