Case Manager RN (H) Remote

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet . The University of Miami UHealth Department of UMHC-SCCC Business Operations has an exciting opportunity for a full time Case Manager RN. The incumbent coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. Develops a discharge plan that provides the best available resources to meet ongoing patient needs and that encourages compliance with medical advice. Identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care. CORE JOB FUNCTIONS Identifies the patients’ risk factors or obstacles to care, and discharge and readmission risk. Evaluates the plan of care regularly by chart review and patient interviews, as well as collaborates with the medical team to facilitate the patients’ movement through the system. Educates patients and families on the progression of care. Serves as a liaison between patients, families, and healthcare personnel to ensure necessary care is provided promptly, effectively, and in a fiscally responsible manner. Promotes quality care to ensure patients receive medically appropriate services in appropriate status and stay standards. Facilitates ongoing insurance authorization for continued stay. Facilitates regulatory notifications and patient signatures per policy. Maintains knowledge regarding insurance reimbursement policies. Relies on experience and judgement to plan and facilitate discharge and transition plans, and assures they meet the physical, social, and emotional needs of the patient. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: Bachelor’s Degree Certification and Licensing: Registered Nurse Licensing (RN) Experience: Minimum 2 years of relevant experience Knowledge, Skills and Attitudes: Ability to communicate effectively in both oral and written form. Ability to recognize, analyze, and solve a variety of problems. Ability to analyze, organize and prioritize work under pressure while meeting deadlines. Ability to maintain effective interpersonal relationships. The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Job Status: Full time Employee Type: Staff

RN

Utilization Case Manager (Remote)

University of Miami Health System

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet . UMHC-SCCC - Business Operations has an exciting opportunity for a Full time, Remote, Utilization Case Manager position, The incumbent is to complete ongoing reviews for clinical utilization and identifying the need for continued authorization. The Utilization Case Manager coordinates with the Nurse Case Manager as well as the Healthcare team for optimal patient outcomes, while avoiding potential treatment delays and authorization denials. The Utilization Case Manager is accountable for a designated patient caseload and ensures that all necessary criteria for continued authorization remains in place. At all times the case manager provides communication of progress and or determination to the clinical team and or the patient. CORE JOB FUNCTIONS Adhere and perform timely reviews for services requiring an authorization for continuation of care Follows the authorization process using established criteria as set forth by the payer or clinical guidelines Accurate review of coverage benefits and limitations to determine continued appropriateness of services requested Facilitates interdepartmental communication regarding status of continued authorization in advance of patient’s appointment. Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient. Identifies potential delays in treatment by reviewing the treatment plan and proactively communicates with the healthcare team and or patient regarding the potential treatment barrier Maintains knowledge regarding payer reimbursement policies and clinical guidelines. Adheres to University and department level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Bachelor’s degree in relevant field; or equivalent Minimum of 2 years of relevant experience The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Job Status: Full time Employee Type: Staff

Nurse Navigator 1 - Site Disease Group - Remote/Full Time

University of Miami Health System

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet . Location: Remote The Nurse Navigator 1 (H) is the initial point of contact for a patient entering the health system and assures timely scheduling of the first appointment, and coordination of care after completion of the first appointment and supports the patient throughout the care continuum. The Nurse Navigator 1 (H) serves as a liaison between patients, families, caregivers, and the multidisciplinary care team. The incumbent demonstrates a commitment to quality patient care, implements creative and innovative ways to meet the diverse needs of the patients and ensures best practices. CORE JOB FUNCTIONS 1. Triages new patient appointments to the appropriate provider(s) and assures timely scheduling of initial appointments. 2. Reviews outside medical records for appropriate scheduling. 3. Assess barriers to care and refers to support services, local, and national organizations when needed. 4. Educates on the treatment plan for patients based on diagnosis. 5. Supports patients throughout the care continuum. 6. Counsels individuals and patients on positive health practices. 7. Collaborates with a multidisciplinary team of experts to outline the best treatment for patients. 8. Performs holistic evaluation of specialty population, making use of enhanced proven techniques and procedures to achieve better results. 9. Implements the improvement of patient care, and healthcare policies and resources. 10. Mentors other healthcare professionals by functioning as a preceptor or coordinating preceptors for visiting professionals, students, new graduates, and orienteers. 11. Maintains professional knowledge by affiliating with professional and technical organizations, and participating in applicable continuing education programs, conferences, seminars, and workshops. 12. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: Bachelor’s degree in relevant field Certification and Licensing: Valid State of Florida Registered Nurse (RN) license Experience: Minimum 2 years of relevant work experience Knowledge, Skills and Attitudes: • Ability to maintain effective interpersonal relationships. • Ability to communicate effectively in both oral and written form. • Skill in collecting, organizing and analyzing data. • Proficiency in computer software (i.e., Microsoft Office). Department Specific Functions Assess patient needs upon initial encounter and periodically throughout navigation, matching unmet needs with appropriate referrals and support services. Identifies potential and realized barriers to care and facilitates referrals as appropriate to mitigate barriers. Reviews, patients’ medical records, test results and any other documentation required for the first visit. Facilitates timely scheduling of appointments, diagnostic testing, and procedures to expedite the plan of care and to promote continuity of care. Participates in coordination of the plan of care with the multidisciplinary team, promoting timely follow-up on treatment and supportive care recommendations. Serves as a liaison for patients, families, caregivers, staff, and referring physicians Orients and educates patients, families, and caregivers to the cancer healthcare system, multidisciplinary team member roles and available resources. Help to explain treatment recommendations to patients and caregivers and appropriately answer questions. Communicates with physicians as needed by phone, emails or in person for new patient referrals and scheduling priorities. Help eligible patient’s access appropriate clinical trials Work with oncology administrators to understand any changes in reporting metrics. Identify bottlenecks in the patient pathway and gaps in care; propose process improvement measures to address them Communicates with other staff to coordinate patient care activities. Participate with other members of the healthcare team to provide patients with supportive care services. Refers patients to local and national community support groups/services Coordination of Educational Activities : Identify and document individual patient’s barriers to learning Educate patients and families about disease process, treatment options, potential side effects Assist patients with treatment decision making; develop and use decision aids as appropriate Provide pre and post-operative education to all groups Educate patients about survivorship, set expectations for the post-treatment transition, remain available to patients and families for questions during the continuum of treatment and at survivorship. Assist with identification of survivors and delivery of the survivorship care plan. Advocate for patient and support with end-of-life/palliative care decisions Educate patients and families about diet, exercise, smoking cessation and other wellness and cancer prevention strategies Psychosocial Support Administer psychosocial screening at patients’ at time of intake; repeat screening at regular intervals or as needed Make referrals to social worker, financial counselor, or support services as needed; facilitate scheduling and monitor patients to ensure follow-though Check in with patients via phone on day prior to surgery and/or treatment start; ensure patients know exactly what to expect before, during and after procedure Facilitates shared decision making with the patients, caregivers, families, and care team. Supports a smooth transition of patients from active treatment into survivorship, chronic cancer management, and end-of life care. Promotes advances care planning by assisting patients in formulating a discussion with their care team. Multidisciplinary Clinical Support Help determine which patients are eligible for clinical trial participation. Facilitate new patient referrals into the clinical trials program. Attend Tumor Board Conference and be available for coordination of care recommended post conference. Maintain communication with the tumor registry when needed. Actively solicit and record feedback from referring physicians and their staff; develop recommendations for improving clinical operations to better meet their needs Meet with physicians who have the potential to become referral sources for the cancer program to provide information about the cancer center and its related programs. Track new patients throughout the care continuum through the EPIC and ensure key follow-up time points are met. Ensures documentation of patient encounter and provided services. Collaborate with marketing and communications departments in events as needed. Assist in developing patient education materials. Develop collaborative relationships with local individuals, agencies and organizations that provide cancer education and support for cancer patients Collaborate with community outreach programs designed to increase public awareness of cancer, cancer prevention and the importance or regular screening Leadership Responsibilities : Must be able to perform job duties as an independent professional and as a team player; organizational skills sufficient to set own priorities and facilitate work team progress. Contributes to the nurse navigator program and role development, implementation, and evaluation within the healthcare system and community. Orients new staff to their group and is cross trained to other groups Attends staff meetings and other meetings as needed Ensure compliance with mandatory in-services and employee health procedures. Actively supports and participates in performance improvement activities Ensures compliance with all facility policies and procedures and all HIPPA, ACHA, JCAHO, OSHA standards and regulations The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Job Status: Full time Employee Type: Staff

Nurse Navigator 1 - Site Disease Group - Full Time/Remote

University of Miami Health System

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet . Location: Remote CORE JOB FUNCTIONS Triages new patient appointments to the appropriate provider(s) and assures timely scheduling of initial appointments. Reviews outside medical records for appropriate scheduling. Assess barriers to care and refers to support services, local, and national organizations when needed. Educates on the treatment plan for patients based on diagnosis. Supports patients throughout the care continuum. Counsels individuals and patients on positive health practices. Collaborates with a multidisciplinary team of experts to outline best treatment for patients. Performs holistic evaluation of specialty population, making use of enhanced proven techniques and procedures to achieve better results. Implements the improvement of patient care, and healthcare policies and resources. Mentors other healthcare professionals by functioning as a preceptor or coordinating preceptors for visiting professionals, students, new graduates, and orienteers. Maintains professional knowledge by affiliating with professional and technical organizations, and participating in applicable continuing education programs, conferences, seminars, and workshops. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: Bachelor’s Degree Certification and Licensing: Registered Nurse Licensing (RN) Experience: Minimum 2-3 years of relevant work experience Knowledge, Skills and Attitudes: Ability to maintain effective interpersonal relationships Ability to communicate effectively in both oral and written form Skill in collecting, organizing and analyzing data Proficiency in computer software (i.e. Microsoft Office) and Electronic Medical Record system(s) Department Specific Functions Assess patient needs upon initial encounter and periodically throughout navigation, matching unmet needs with appropriate referrals and support services. Identifies potential and realized barriers to care and facilitates referrals as appropriate to mitigate barriers. Reviews, patients’ medical records, test results and any other documentation required for the first visit. Facilitates timely scheduling of appointments, diagnostic testing, and procedures to expedite the plan of care and to promote continuity of care. Participates in coordination of the plan of care with the multidisciplinary team, promoting timely follow-up on treatment and supportive care recommendations. Serves as a liaison for patients, families, caregivers, staff, and referring physicians Greet patients on the day of clinic and provide them with personalized schedule, education, and appropriate resources. Orients and educates patients, families, and caregivers to the cancer healthcare system, multidisciplinary team member roles and available resources. Help to explain treatment recommendations to patients and caregivers and appropriately answer questions. Work with referring physicians to understand their preferences for communication about patients’ test results, treatment progress and manage those communications Communicates with physicians as needed by phone, emails or in person for new patient referrals and scheduling priorities. Help eligible patient’s access appropriate clinical trials Track individual patients’ progress along care continuum; identify potential bottlenecks and perform appropriate interventions Work with oncology administrators to understand any changes in reporting metrics. Identify bottlenecks in the patient pathway and gaps in care; propose process improvement measures to address them Communicates with other staff to coordinate patient care activities. Participate with other members of the healthcare team to provide patients with supportive care services. Refers patients to local and national community support groups/services Coordination of Educational Activities : Identify and document individual patient’s barriers to learning Educate patients and families about disease process, treatment options, potential side effects Assist patients with treatment decision making; develop and use decision aids as appropriate Provide pre and post-operative education to all groups Educate patients about survivorship, set expectations for the post-treatment transition, remain available to patients and families for questions during the continuum of treatment and at survivorship. Assist with identification of survivors and delivery of the survivorship care plan. Advocate for patient and support with end-of-life/palliative care decisions Educate patients and families about diet, exercise, smoking cessation and other wellness and cancer prevention strategies Psychosocial Support Administer psychosocial screening at patients’ at time of intake; repeat screening at regular intervals or as needed Make referrals to social worker, financial counselor, or support services as needed; facilitate scheduling and monitor patients to ensure follow-though Check in with patients via phone on day prior to surgery and/or treatment start; ensure patients know exactly what to expect before, during and after procedure Facilitates shared decision making with the patients, caregivers, families, and care team. Supports a smooth transition of patients from active treatment into survivorship, chronic cancer management, and end-of life care. Promotes advances care planning by assisting patients in formulating a discussion with their care team. Multidisciplinary Clinical Support Help determine which patients are eligible for clinical trial participation. Facilitate new patient referrals into the clinical trials program. Attend Tumor Board Conference and be available for coordination of care recommended post conference. Maintain communication with the tumor registry when needed. Actively solicit and record feedback from referring physicians and their staff; develop recommendations for improving clinical operations to better meet their needs Meet with physicians who have the potential to become referral sources for the cancer program to provide information about the cancer center and its related programs. Track new patients throughout the care continuum through the EPIC and ensure key follow-up time points are met. Ensures documentation of patient encounter and provided services. Collaborate with marketing and communications departments in events as needed. Assist in developing patient education materials. Develop collaborative relationships with local individuals, agencies and organizations that provide cancer education and support for cancer patients Collaborate with community outreach programs designed to increase public awareness of cancer, cancer prevention and the importance or regular screening Leadership Responsibilities : Must be able to perform job duties as an independent professional and as a team player; organizational skills sufficient to set own priorities and facilitate work team progress. Contributes to the nurse navigator program and role development, implementation, and evaluation within the healthcare system and community. Orients new staff to their group and is cross trained to other groups Attends staff meetings and other meetings as needed Ensure compliance with mandatory in-services and employee health procedures. Actively supports and participates in performance improvement activities Ensures compliance with all facility policies and procedures and all HIPPA, ACHA, JCAHO, OSHA standards and regulations The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Job Status: Full time Employee Type: Staff

Clinical Reviewer-PRN (RN) (Remote)

Acentra Health

$28.37 - $38 / hour

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles. Job Summary and Responsibilities: Acentra Health is looking for a Clinical Reviewer to join our growing team. Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. ***Position is remote*** ** Required Work Hours: On-call weekends, holidays and evenings** Responsibilities: Assures accuracy and timeliness of all applicable review type cases within contract requirements. Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department. In collaboration with Supervisor, responsible for quality monitoring activities. Maintains current knowledge base related to review processes and clinical practices. Functions as providers' liaison for customer service issues and problem resolution. Performs all applicable review types as workload indicates. Fosters positive and professional relationships with internal and external customers. Attends training and scheduled meetings for current/updated information. Cross trains to provide flexible workforce to meet client/customer needs. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time. Qualifications: Required Qualifications Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License. A minimum of 2+ years of experience with federal CMS case processing. Knowledge of medical records and medical terminology. Skilled in reviewing, interpreting, and abstracting data from medical records. Strong clinical assessment and critical thinking skills. Excellent verbal and written communication skills. Must be proficient in Microsoft Office and internet/web navigation. Preferred Qualifications Knowledge of IRO Accreditation (URAC) standards. Knowledge of Independent Review Organization (IRO). Knowledge of Medicare (CMS) guidelines. Experience with Medical Appeals. Ability to work in a team environment. Flexibility and strong organizational skills. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. This position includes access to select Acentra Health benefits and programs, such as participation in the Acentra Health 401(k) Plan with company match, access to wellness and employee discount programs, and Employee Assistance Program (EAP) resources. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process. ~ The Acentra Health Talent Acquisition Team Visit us at http://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Compensation The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.” Pay Range: USD $28.37 - USD $38.00 /Hr.

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