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Registered Nurse, Care Manager

 

Registered Nurse, Care Manager

Department: ORMC Care Management
Status:
Full Time
Shift:
Day
ReqID: req26979

The Care Manager promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient 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.

The position will be for our non emergent transfer center. You will need to have strong clinical skills with Utilization review, as you will work closely with the MDs on medically necessity for our level 1 trauma care.

Education/Training

  • Graduate of an approved school of nursing.

Licensure/Certification

  • Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
  • BLS/Healthcare Provider Certification within 90 days of hire.

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:
    • Accurate medical necessity screening and submission for Physician Advisor review
    • 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.
    • 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 patients 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 patients 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.
  • Possesses excellent interpersonal skills and ability to work in a team environment.
  • Respects the rights and privacy of others and holds staff member information in strict confidence.
  • Maintains regular attendance and complies with time and attendance policy and procedures.
  • Adheres to Orlando Healths policies and procedures, Mission, Vision and Values statement and Code of Conduct.
  • Enhances professional growth by participating in educational programs, current literature and/or workshops.

Other Related Functions

  • 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.
  • Required skills include 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 and computer literacy.

ADDRESS: 3090 Caruso Court Orlando FL 32806

ABOUT ORLANDO HEALTH

Orlando Health is one of Florida's most comprehensive private, not-for-profit healthcare networks, and is based in Orlando, FL. Our facilities, advanced medical treatments and procedures, and highly qualified staff have distinguished Orlando Health as a healthcare leader for nearly two million Central Florida residents and 10,000 international visitors annually. Click here to learn more about Orlando Health.


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