RN Care Manager, Behavioral Health

Orlando Health • Longwood, FL

273d

About The Position

The RN Care Manager for Behavioral Health promotes and facilitates effective management of hospital resources from admission to discharge. This role involves collaborating with the assigned clinical team to identify patients who are most likely to benefit from care coordination services. Responsibilities include assessing patients' risk factors and the need for care coordination, clinical utilization management, and transitioning to the next appropriate level of care.

Requirements

• Graduate of an approved school of nursing.
• Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
• BLS/Healthcare Provider Certification within 90 days of hire.
• Handle with Care (HWC) Certification required for Behavioral Health Unit.
• 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 including accurate medical necessity screening and submission for Physician Advisor review.
• Coordinates care 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.
• Adds 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.
• Educates 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 regular attendance and complies with time and attendance policy and procedures.
• Adds to Orlando Health's policies and procedures, Mission, Vision and Values statement and Code of Conduct.

What This Job Offers

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