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

Orlando Health•St. Petersburg, FL

2d•Onsite

About The Position

The RN Care Manager coordinates patient care across the continuum, promoting safe, efficient, and appropriate use of healthcare resources and quality outcomes. The role facilitates hospital resource management from admission through discharge, working with clinical teams to identify patients who may benefit from care coordination, assess risk and coordination needs, support utilization management, and plan transitions to the next appropriate level of care. The selected candidate must have a strong clinical and case management background and be able to work independently. This position also assists with completing discharge needs from the day shift and provides emergency department assistance with admission criteria. The position is based at Orlando Health Bayfront Hospital in St. Petersburg, Florida. It is a full-time, second/mid-shift role scheduled from 3 p.m. to 11 p.m., Sunday through Thursday, with holiday rotation. The RN Care Manager performs initial and concurrent patient assessments, medical necessity screening, care coordination, utilization and length-of-stay management, and transition planning. The role leads multidisciplinary care conferences and complex case reviews, addresses disputes and avoidable days, makes appropriate referrals, communicates with patients, families, clinicians, and payers, and supports compliance with regulatory, accreditation, and managed-care requirements. The position also monitors clinical and fiscal outcomes, identifies improvement opportunities and quality or risk issues, and maintains organized, confidential documentation. Orlando Health Bayfront Hospital is a 480-bed teaching medical center serving St. Petersburg and surrounding communities. The hospital offers a range of recognized services and is part of the Orlando Health system. Orlando Health describes its benefits as including career-growing education programs and well-being services, with benefits beginning on day one.

Requirements

Graduate of an approved school of nursing.
Current Florida RN license, which 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 activities of a diverse group in a fast-paced environment.
Critical-thinking and problem-solving skills.
Computer literacy.
Ability to maintain confidentiality and respect the rights and privacy of others.

Responsibilities

Assess patients upon admission and on an ongoing basis for discharge planning, care coordination, medical necessity, and utilization needs.
Develop and implement individualized care transition and discharge plans.
Coordinate care with physicians, nurses, social workers, therapists, ancillary services, patients, families, caregivers, and third-party payers.
Facilitate transitions to appropriate post-acute services, including skilled nursing facilities, rehabilitation, home health, hospice, durable medical equipment, transportation, and community resources.
Identify social, financial, clinical, cultural, socioeconomic, religious, and other barriers that may affect treatment, recovery, or discharge.
Monitor length of stay, assign an initial DRG to determine GMLOS, identify barriers early, and manage transition planning using assessment, reassessment, and InterQual guidelines.
Conduct medical necessity screening and submit cases for Physician Advisor review when appropriate.
Lead and facilitate multidisciplinary patient care conferences and complex case reviews.
Manage concurrent disputes and make appropriate referrals, including referrals of complex patients to Social Work Services.
Educate patients, families, caregivers, and physicians about care plans, treatment options, procedures, therapies, and discharge plans.
Identify and document potentially avoidable days and report overutilization and underutilization.
Ensure compliance with applicable regulatory and accreditation standards, managed contracts, Medicare, Medicaid, campus requirements, and the Utilization Management Plan.
Support utilization management, denial prevention, appropriate length of stay, readmission prevention, patient satisfaction, and efficient care throughput.
Monitor and evaluate data, fiscal outcomes, and other relevant information; develop and implement improvement strategies and appropriately forward quality or risk issues.
Maintain positive relationships with outside and onsite reviewers and payer representatives.
Prioritize work toward high-risk, high-cost, and problem-prone areas while managing multiple priorities in a fast-paced environment.
Maintain organized, retrievable, and confidential records and documentation, and keep current with relevant literature and reimbursement information.
Participate in educational programs, workshops, committees, and task forces supporting professional growth and quality, cost-effective care.
Assist with day-shift discharge needs and provide emergency department assistance with admission criteria.
Maintain regular, punctual attendance and comply with Orlando Health policies and procedures.
Perform other duties as assigned or required.