Functions as a key member of the health care team responsible for ensuring efficient, accurate data collection of retrospective review and concurrent review cases. Role functions include the facilitation of timely and appropriate medical case review for Commitment to Quality (CTQ - Core Measures) as well as state and regulatory agency requirement reviews to ensure compliance. Active participant of the Hospitalwide Performance Improvement Committee. Position reports to the Director of Clinical Quality Improvement.
Foreign Medical Graduate, Completion of Medical Degree from an accredited Foreign Medical School.
R.N, L.P.N: Licensure in the State of Florida as a Registered Nurse or License Practical Nurse.
Graduate of an accredited school of professional nursing.
(2) Two years acute care clinical experience as a R.N, L.P.N. or Foreign Medical Graduate a must. Knowledgeable in data analysis collection, medical/surgical case reviews, reimbursement methodologies, performance improvement principles, tools and techniques. Management skills with an emphasis on communication and negotiation and the ability to function independently within a team framework are essential.
Requires knowledge of State and Federal regulatory agency standards and required reviews. Must possess analytical and clinical skills and be detail oriented. Cognitive and technical knowledge and the ability to retrieve data, analyze and communicate outcome to appropriate channels.
Job : Case Management/Home Health
Primary Location : FL-Coral Gables
Hospital/Facility : 159-Coral Gables Hospital - Coral Gables, FL
Job Type : Full-time
Shift Type : 8 Hour Day