North Florida Regional Healthcare is an organization centered around the community hospitals in Gainesville, Florida -- North Florida Regional Medical Center (NFRMC) and Lake City Medical Center (LCMC). NFRMC is a 432-bed, full-service medical and surgical acute care center serving North Central Florida and offering comprehensive cardiovascular care, oncology, orthopedics, neurosciences, minimally-invasive laparoscopic and robotic surgery, weight loss surgery and treatment, women’s health and wound therapy, among other services.
Responsibilities
- Coordinates the collaborative case management process.
- Assists with providing statistical data for Medical Staff Committees as requested, related to Utilization Review Management.
- Prepares reports for committees in cooperation with the Chair of the URM committee.
- Monitors qualitative/quantitative indicators per InterQual criteria, appropriateness of admissions and utilization of resources.
- Analyses data for trends of improvement and/or areas of concern and recommends appropriate actions related to case management throughout the continuum of care.
- Maintains mechanism to follow-up on areas of concern.
- Reviews patient records as requested for QI issues.
- Monitors for JCAHO, state and regulatory compliance related to Case management.
- Designs methodology for tracking review of patients for criteria and authorizations.
- Assists with daily self-pay flash meetings, as well as seeks resources available for the self-pay/indigent population, collaboratively with the CM’s and MD’s.
- Coordinates and has oversight of primarily concurrent and retrospective review of records related to patient days.
- Works cooperatively with Health Information Management Department’s procedure in requesting and returning records for discharge dispositions.
Education and Experience
- Graduate of an accredited school of nursing as an RN. BSN preferred. MSN, MBA or Master’s degree in related field preferred.
- 5 to 8 years related case management experience.
- Minimum of 3 years hospital acute care case management experience.
- Successful leadership/management experience within matrixed, corporate organizations.
- RN license in the State of Florida. CCM Certification is preferred.
- Demonstrated success and abilities in leadership, achieving results, communications, customer service and health care management.
- Demonstrates assertive and diplomatic communication skills with a leadership style that initiates engagement, collaboration and direction with clearly defined expectations. Demonstrated results in the implementation of length of stay reduction and accountable reporting through metrics.
Compensation commensurate with experience with salary range between $100-$115k/yr. plus a 10% bonus potential.
