RN Case Manager - Case Management

Health First Careers•Viera West, FL

About The Position

The RN Case Manager provides quality, safe, customer-focused care and responsible resource stewardship by applying advanced clinical skills to assess, plan, intervene, and evaluate patient care. The role follows federal Conditions of Participation, Florida regulations, and The Joint Commission accreditation standards. Working with the interdisciplinary team, patients, families, and support personnel, the RN Case Manager promotes optimal clinical outcomes through effective resource utilization and discharge planning for hospital admissions. This is a weekends-only position, with Saturday and Sunday shifts from 9:00 a.m. to 5:30 p.m. It is listed as part-time.

Requirements

Associate Degree in Nursing.
Current, valid Florida RN license or endorsement.
Current American Heart Association Basic Life Support Healthcare Provider Completion Card upon hire and maintained.
At least three years of clinical experience in an acute care hospital.
Strong analytical, data management, and computer skills.
Excellent interpersonal communication and negotiation skills.
Demonstrated critical thinking in resolving or escalating barriers.
Ability to work autonomously and prioritize multiple tasks and role components.
Ability to exercise sound judgment when interacting with physicians, payers, patients, and families.
Flexibility to meet needs in high-demand and stressful situations.

Nice To Haves

BSN or bachelor's degree in a related field.
CCM or ACM certification.
Case management experience in an acute care hospital.
Knowledge of care transitions, utilization management, case management, performance improvement, and managed care reimbursement.
Comprehensive knowledge of post-acute community resources across the continuum of care.

Responsibilities

Begin care transition planning at admission and develop or revise individualized discharge plans based on patient assessment, reassessment, and response to treatment.
Manage length of stay, promote efficient resource utilization, and plan for safe discharge.
Identify at-risk populations using approved screening tools and follow referral processes to support safe transitions and prevent readmissions.
Practice autonomously in accordance with evidence-based standards.
Serve as a case management resource for compliance with Medicare IM letters, 3008, 1823 PASSR, DCF mandatory legal reporting, and related requirements.
Collaborate with the Utilization Department, Physician Advisors, Hospitalists, Emergency Department, and other physicians to support appropriate, cost-effective care and patient outcomes.
Identify, resolve, or escalate discharge delays and obstacles.
Identify reimbursement factors affecting post-hospital provider selection and obtain authorizations directly or in collaboration with payer case managers.
Evaluate the effectiveness of each patient's daily plan and involve the patient and family in setting plan goals.
Maintain active communication with physicians, nursing, physician advisors, and other interdisciplinary care team members to support timely resource management and patient transitions.
Support patient rights, informed consents, and advance directives.
Initiate referrals to the ethics committee, clinical social worker, risk management, or legal services when appropriate.