RN Care Manager - Acute Case Management - Days - Bayfront Hospital

Orlando Health•Saint Petersburg, FL

17h•Onsite

About The Position

Orlando Health Bayfront Hospital is seeking an RN Care Manager to join their Acute Case Management team. This full-time, day shift position involves coordinating patient care across the continuum, ensuring safe, efficient, and appropriate utilization of healthcare resources while focusing on quality outcomes. The RNCM will promote and facilitate effective management of hospital resources from admission to discharge, collaborating with the clinical team to identify patients who would benefit from care coordination services. This includes assessing patients’ risk factors, need for care coordination, clinical utilization management, and facilitating 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.
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
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

Assess patients upon admission for discharge planning needs.
Develop and implement individualized care transition plans.
Collaborate with physicians, nurses, social workers, therapists, and ancillary services.
Ensure smooth transitions to post-acute care (SNF, rehab, home health, hospice).
Prevent avoidable delays in care or discharge.
Monitor length of stay (LOS) and address barriers early.
Participate in payer communication and authorization processes.
Identify social, financial, and clinical barriers to discharge.
Coordinate with families and caregivers.
Arrange services such as DME, home health, transportation, or community resources.
Ensure safe and timely discharge to the appropriate level of care.
Educate patients and families about care plans and options.
Promote informed decision-making.
Address Social Determinants of Health (SDOH) impacting recovery.
Maintain accurate documentation supporting medical necessity.
Ensure regulatory and accreditation standards are met.
Participate in quality improvement initiatives.
Accurate medical necessity screening and submission for Physician Advisor review.
Care coordination including 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.
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.
Leading and facilitating multi-disciplinary patient care conferences.
Managing concurrent disputes.
Making appropriate referrals to other departments.
Identifying and referring complex patients to Social Work Services.
Communicating with patients and families about the plan of care.
Leading and facilitating Complex Case Review.
Identification and documentation of potentially avoidable days.
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.
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, Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care.
Education provided 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.
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.