Registered Nurse Care Manager at Lake Mary Hospital

Orlando Health•Lake Mary, FL

6d•Onsite

About The Position

Orlando Health Lake Mary Hospital is seeking a Registered Nurse Care Manager, Acute to join their team. This is a variable full-time position working three 12-hour shifts per week, from 7:00 PM to 7:00 AM. Orlando Health Lake Mary Hospital is a new, comprehensive acute care facility serving the Seminole County community, offering a full scope of medical and surgical services. The hospital features state-of-the-art facilities and modern amenities designed for patient comfort and exceptional medical care. This role offers unique opportunities for career advancement, leadership, and professional development within a highly-rated workplace.

Requirements

Graduate of an approved school of nursing.
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
Must hold and maintain a current Florida RN license.
Handle with Care (HWC) Certification is required for the Behavioral Health Unit within 90 days of hire.

Nice To Haves

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
Computer literacy

Responsibilities

Initially and concurrently assesses all patients within assigned population to include accurate medical necessity screening and submission for Physician Advisor review.
Provides 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.
Assigns 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.
Leads and facilitates multi-disciplinary patient care conferences.
Manages concurrent disputes.
Makes appropriate referrals to other departments.
Identifies and refers complex patients to Social Work Services.
Communicates with patients and families about the plan of care.
Leads and facilitates Complex Case Review.
Identifies and documents potentially avoidable days.
Identifies and reports 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.
Integrates National standards for care management scope of services including: Utilization Management supporting medical necessity and denial prevention, Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction, and Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care.
Provides education to physicians, patients, families, and caregivers.
Communicates appropriately and timely with the interdisciplinary team and third-party payers.
Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas.
Develops collaborative relationships with patient business, nursing, physicians, and patient/family to facilitate efficient movement through the continuum of care.
Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement.
Forwards identified quality and/or risk issues appropriately.
Maintains positive relationships with outside/onsite reviewers and other payer representatives.
Identifies cultural, socio-economic, religious, and other factors that may impact treatment.
Involves patient’s family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family.
Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members.
Prioritizes workload to manage multiple priorities while using problem-solving skills to meet goals.
Enhances professional growth by participating in educational programs, current literature and/or workshops.
Possesses excellent interpersonal skills and ability to work in a team environment.
Respects the rights and privacy of others and holds staff member information in strict confidence.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
Maintains compliance with all Orlando Health policies and procedures.
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.
Performs other duties as assigned or required.