Utilization Review Registered Nurse in Hialeah, FL

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. Department: CC019054 Eldercare Job Description Summary: Position Responsibilities • Participant Care Activities • 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. • Planning • Re-evaluates plan of care as required by Eldercare standards and practices. • Establishes priorities for participant care based on participant needs as evidenced by completion of assigned duties. • Implementation • Uses nursing skills to determine participant clinical needs and assists the interdisciplinary team as needed. • Safely and correctly initiates and documents nursing interventions in emergency situations. • Perform in-house lab tests; obtain and process specimens for outside laboratories. Performs wound care and other nursing interventions as ordered by the physician or included in the plan of care. • Administers, observes, and documents intravenous therapy according to Eldercare policy. • Administers medications as required by physician orders. • Provides individualized instructions to participant/significant others regarding the plan of care. • Demonstrates safe and correct use of equipment. • Ensures that each participant's needs are met. • Take and record vital signs, recognize any variances, outliers or red flags, and take appropriate action. • Adheres to standard precautions including hand hygiene guidelines at all times. • Documents orders and other pertinent items as needed. • Reports all abnormal findings immediately to physician. • Performs and assists in procedures as needed. • Is able to administer oxygen therapy following physician's orders. • Evaluation • Documents/reports participant responses or outcomes resulting from: discharge planning or care transition activities, nursing interventions, treatments/procedures, interpersonal interactions, and participant/family education. • Evaluates and documents participant's progress towards established goals/objectives. • Updates/revises participant care problem list and individualized participant care standards based on participant/family responses, progress towards goals, and/or change in medical status. • Evaluates planning needs based on anticipated problems, internal or community resources, and support systems. • Professional and Staff Development • Completes 100% of the mandatory Eldercare and hospital specific in-services annually or as assigned, prior to the due date. • Establish, build and maintains community relationships to ensure continuity and continuation of care. • Collaborate with the Enrollment team for marketing, in-services and presentation needs. • Documents competency in clinical skills annually. • Attends staff meetings as required. • Uses established lines of communication for resolution of problems and interpersonal conflict. • Leadership • Ensures productivity daily and evaluates completion of duties assigned. • Fills in for Home Care Manager as needed, conducting home visits and initiating initial home assessments. • Fills in for Clinic Manager as needed, overseeing the clinic and its daily activities. • Fills in for the Center Manager as needed, overseeing the day center and its activities. • Participates in QI activities. Qualifications • License/Registration/Certification • Current RN Licensure in State of Florida. BLS and CPR required. • Education • Graduated from accredited school of registered nursing., • Experience • 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: • 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 select positions and more! Degree Requirements: Certification: