Job Description

Utilization Review Registered Nurse

As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring: The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Position Responsibilities:

• Responsible to initiate and monitor service utilization including hospital, sub-acute, and post acute care utilized by participants.
• Works with acute, sub-acute, and post acute providers to ensure medical care provided is at the appropriate level for the current needs of the participant and proactively works with providers to make the changes needed to ensure the participants care needs are continually met.
• Identifies reports and resolves actual or potential delays in service and assures appropriate use of resources.
• Development of plan of care for participants in collaboration with family, participant, caregiver, facilities and interdisciplinary team to facilitate a timely and safe discharge.
• Attends medical rounds and/or care conferences in the hospital, nursing homes, or other in-patient care settings to evaluate the length of stay and utilization.
• Works with case management or discharge planning facilities to assist in discharge planning or care transitions in a timely and safe manner.
• Makes routine visits to nursing home, assisted living facilities, hospitals, group homes and other home settings to assist in care coordination and ensure the participant is receiving the care designated in the plan of care.
• Assists participants, families and caregivers with End of Life Care needs.
• Complete the Department of Elder affairs 703B assessment as needed on participants.
• As needed conducts in person comprehensive initial and on going nursing assessments.
• Counsels participants and families regarding health education, preventative health and chronic condition needs.
• Provides on-call coverage on a rotating basis with other staff to troubleshoot, advise and coordinate participant care.
• Covers for the Clinic Manager, Home Care Coordinator and/or Center Manager as needed.
• Responds to diagnostic data and initiates appropriate action or intervention.

Qualifications:

• Current RN Licensure in State of Florida. BLS and CPR required.
• Graduated from accredited school of registered nursing.
• One year clinical experience required. Experience in utilization review and/or case management in managed care, workers compensation or other health care setting is preferred. Geriatric physician office, or other case management experience is acceptable.

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for selected positions and more!

Job Tags

Similar Jobs