RN Care Manager, Acute

Orlando Health • Orlando, FL

101d

About The Position

The RN Care Manager at Orlando Regional Medical Center (ORMC) is responsible for promoting and facilitating effective management of hospital resources from admission to discharge. This role involves collaborating with the assigned clinical team to identify patients who would benefit from care coordination services. The RN Care Manager will assess patients' risk factors and needs for care coordination, clinical utilization management, and transitions to the next appropriate level of care.

Requirements

• Graduate of an approved school of nursing.
• 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.
• Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.

Responsibilities

• Initially and concurrently assesses all patients within assigned population.
• Conducts accurate medical necessity screening and submission for Physician Advisor review.
• Coordinates care including admitting diagnosis, medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, and other relevant information.
• Assigns initial DRG to determine GMLOS and monitors LOS and transition planning.
• 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.
• Adheres to Utilization Management Plan.
• Integrates National standards for care management scope of services.
• 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.
• 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.
• Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing.
• Prioritizes workload to manage multiple priorities while using problem-solving skills.
• 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.

What This Job Offers

• Job Type: Full-time
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree