RN Care Manager, Acute at Orlando Health

Orlando, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Jul, 26

Salary

0.0

Posted On

20 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Care management, Care coordination, Utilization management, Acute clinical care, Medical necessity screening, InterQual guidelines, Patient assessment, Transition planning, Multi-disciplinary patient care conferences, Chronic disease management, Documentation, Referral management, Clinical utilization review, Patient advocacy

Industry

Hospitals and Health Care

Description

Position Summary RN CARE MANAGER, ACUTE Orlando Regional Medical Center (ORMC) ORMC Care Management Department (North or South Tower) Full Time - Monday - Friday 8:00am - 4:00pm Position Summary Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patients most likely to benefit from care coordination services to include assessing patients’ risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care. Education/Training • Graduate of an approved school of nursing. Licensure/Certification • Must hold and maintain a current Florida RN license. • Handle with Care (HWC) Certification is required for the Behavioral Health Unit within 90 days of hire. The Handle with Care training and education will be provided onsite to all team members. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Essential Functions • Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review o Care coordination 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. o 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. o Leading and facilitating multi-disciplinary patient care conferences o Managing concurrent disputes o Making appropriate referrals to other departments o Identifying and referring complex patients to Social Work Services o Communicating with patients and families about the plan of care o Leading and facilitating Complex Case Review o Identification and documentation of potentially avoidable days o Identification and reporting over and underutilization

Responsibilities

The RN Care Manager facilitates effective resource management from admission to discharge by assessing patient risk factors and coordinating care. They lead multi-disciplinary conferences and ensure appropriate transitions to the next level of care while monitoring medical necessity.