RN Care Manager - Acute Case Management - 2nd Shift - Bayfront Hospital

Orlando Health•Saint Petersburg, FL

3d•Onsite

About The Position

The RN Care Manager (RNCM) coordinates patient care across the continuum, supporting safe, efficient, and appropriate use of healthcare resources and quality outcomes. The role promotes effective management of hospital resources from admission through discharge and works with the clinical team to identify patients who may benefit from care coordination, assess risk factors and care coordination needs, conduct utilization management, and support transitions to appropriate levels of care. The selected candidate will have a strong clinical and case management background and be able to work independently. The position also assists with completing discharge needs from the day and provides assistance in the emergency department with admission criteria. The RNCM assesses patients and develops individualized transition plans, coordinates with the interdisciplinary team, patients, families, caregivers, and payers, and works to prevent avoidable delays in care or discharge. The role monitors length of stay, identifies barriers, supports authorization and medical-necessity processes, arranges post-acute services, and ensures safe and timely discharge. It also includes documentation, regulatory compliance, quality improvement, education, and advocacy for patients and families. The position is in the Case Management department at Orlando Health Bayfront Hospital in St. Petersburg, Florida. It is a full-time second/mid-shift role, scheduled 3 p.m.–11 p.m. Sunday through Thursday, with holiday rotation.

Requirements

Graduate of an approved school of nursing.
Current Florida RN license that must be maintained.
Three years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
At least some case management experience or background.
Strong clinical background and ability to work independently.
Demonstrated organizational skills.
Excellent verbal and written communication skills.
Ability to lead and coordinate a diverse group of people in a fast-paced environment.
Critical-thinking and problem-solving skills.
Computer literacy.
Excellent interpersonal skills and ability to work in a team environment.

Responsibilities

Assess patients on admission and concurrently for discharge planning, care coordination, medical necessity, and utilization management needs.
Develop and implement individualized care transition and discharge plans.
Coordinate with physicians, nurses, social workers, therapists, ancillary services, patients, families, caregivers, and third-party payers.
Coordinate transitions to skilled nursing facilities, rehabilitation, home health, hospice, and other appropriate levels of care.
Identify social, financial, clinical, cultural, socioeconomic, and other barriers that may affect care or recovery.
Arrange durable medical equipment, home health, transportation, and community resources as needed.
Monitor length of stay and expected length of stay, identify barriers early, document potentially avoidable days, and address over- or underutilization.
Support payer communication, authorization processes, managed-care contract requirements, concurrent disputes, and medical-necessity review.
Apply InterQual guidelines and assign an initial DRG to determine GMLOS while monitoring length of stay and transition planning.
Lead and facilitate multidisciplinary patient care conferences and complex case reviews.
Make referrals to other departments and refer complex patients to Social Work Services.
Educate physicians, patients, families, and caregivers about care plans, options, procedures, therapies, and discharge plans.
Maintain accurate, organized, confidential documentation that supports medical necessity and regulatory and accreditation requirements.
Ensure compliance with applicable Federal, State, Local, Joint Commission, Medicare, Medicaid, campus, and utilization-management requirements.
Participate in quality improvement initiatives, committees, and task forces focused on quality and cost-effective care.
Monitor and evaluate data and fiscal outcomes and develop or implement improvement strategies.
Identify and forward quality or risk issues appropriately.
Maintain positive relationships with outside and onsite reviewers and payer representatives.
Prioritize workload and manage multiple activities in a fast-paced environment using critical thinking and problem-solving skills.
Enhance professional growth through educational programs, literature, and workshops, and keep current with relevant reimbursement information.
Maintain regular, punctual attendance and comply with Orlando Health policies and procedures.
Perform other duties as assigned or required.