Registered Nurse (RN) - Case Manager, Acute Care Case Management
Health Central Hospital
Ocoee, FL

RN Care Manager, Case Managment-Days

Position Summary ORLANDO HEALTH - HEALTH CENTRAL HOSPITAL Located in Ocoee, Florida, Orlando Health - Health Central Hospital is a 252-bed comprehensive medical and surgicalacute-care facility that has been serving the residents of west Orange County for more than 70 years. Services range from 24/7 emergency care to heart and vascular and stroke care, neurosciences, oncology, orthopedics, minimally invasive robotic surgery and more. Our hospital has earned accreditations and designations in many specialty services, including bariatric, spine, stroke, hip replacement and knee replacement. We also have been recognized as a High Performing Hospital in diabetes, heart attack and heart failure by U.S. News & World Report for 2023-2024 and received an "A" Safety Grade from The Leapfrog Group for Spring 2023. Orlando Health - Health Central is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida's east to west coasts and beyond. Collectively, our 27,000+ team members honor our over 100-year legacy by providing professional and compassionate care to the patients, families and communities we serve. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it's our promise to you Position Summary Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care. Responsibilities Essential Functions • Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review o Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information. o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines. o Leading and facilitating multi-disciplinary patient care conferences o Managing concurrent disputes o Making appropriate referrals to other departments o Identifying and referring complex patients to Social Work Services o Communicating with patients and families about the plan of care o Leading and facilitating Complex Case Review o Identification and documentation of potentially avoidable days o Identification and reporting over and underutilization Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval. Adheres to Utilization Management Plan Other Related Functions Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining confidentiality of data and patient information. Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information. Actively serves on committees and task forces to promote quality, cost-effective care for patient population. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy. Performs other duties as assigned or required Qualifications Education/Training Graduate of an approved school of nursing. Licensure/Certification Maintains current Florida RN license and BLS/Healthcare Provider certification are required. BLS/Healthcare Provider Certification within 90 days of hire. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Previous case managment experience is preferred Education/Training Graduate of an approved school of nursing. Licensure/Certification Maintains current Florida RN license and BLS/Healthcare Provider certification are required. BLS/Healthcare Provider Certification within 90 days of hire. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Previous case managment experience is preferred Essential Functions • Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review o Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information. o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines. o Leading and facilitating multi-disciplinary patient care conferences o Managing concurrent disputes o Making appropriate referrals to other departments o Identifying and referring complex patients to Social Work Services o Communicating with patients and families about the plan of care o Leading and facilitating Complex Case Review o Identification and documentation of potentially avoidable days o Identification and reporting over and underutilization Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval. Adheres to Utilization Management Plan Other Related Functions Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining confidentiality of data and patient information. Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information. Actively serves on committees and task forces to promote quality, cost-effective care for patient population. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy. Performs other duties as assigned or required