**Quality Review Nurse RN PRN Home Care** **All the benefits and perks you need for you and your family:** + Benefits from Day One + Paid Days Off from Day One + Career Development + Whole Person Wellbeing Resources + Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Schedule:** Per Diem **Shift** : Day **Location:** VIRTUAL, Orlando, 32804 **The role you’ll contribute:** The Population Health Case Manager (PHCM) ensures effective utilization and case management oversight activities as defined by inter professional best practices, agency policies/processes. Ensures clear and appropriate visit utilization using evidence-based and best practice guidelines to achieve positive clinical outcomes and efficient use of resources. Identifies and collaborates with clinical supervisor on feedback and coaching opportunities of clinical colleagues. Works under supervision of Department Manager **The value you’ll bring to the team:** + Evaluates visits per episode for the optimal utilization that results in the best possible clinical outcomes and efficient use of resources. + Analyzes utilization to ensure visits are made according to episode utilization guidelines and clinical outcomes best practices. Develops/revises utilization policies and practices based on analysis of past practices to improve utilization. + Collaborates with colleagues, and field clinicians to achieve strategic aims, top decile outcomes and patient satisfaction. + Mentors colleagues and encourages implementation of best practice guidelines Case Management: + Determine patient risk for rehospitalization and appropriate care pathway + Evaluate the need for virtual technology + Develop plan of care (POC) and visit frequency and spacing + Identify appropriate services to meet desired clinical and fiduciary outcomes and obtains physician orders if indicated + Evaluates visits per episode for optimal utilization that results in the best clinical outcomes and efficient use of resources + Daily completion of workflow to ensure timely patient care (Bypass stage 1, stage 2) + Handles escalated clinical authorizations and denials, prioritizing timelines/limits Accountability / Fiduciary: + Identifies quality performance improvement opportunities and leads/participates in these activities as needed/directed. + Demonstrates effective, independent judgment in planning, performing activities that lead to consistent achievement of desired outcomes. + Responsible for meeting/exceeding all established common goals and clinical outcomes. + Utilizes clinical reports for relevant patient data and reviews patient's clinical condition in order to determine appropriate authorization. + Reviews initial clinical documentation at identified timepoints (Admission, Add-on Eval, ROC, Recert and Discharge), for identified episodic payors, approves additional services. + Align clinical pathways in accordance to standard work. + Meets departments workflow and productivity standards. **The expertise and experiences you’ll need to succeed** **:** **Minimum qualifications:** + Registered Nurse with current license from the state in which practicing **Preferred qualifications:** + Degree: Bachelor's degree + Care Management, Case Management other applicable certifications preferred. + OASIS certification required within 6 months of hire in the role This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Home Care Central Florida **Schedule:** Per Diem **Shift:** 1 - Day **Req ID:** 24044436 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.