RN Care Manager - Acute Case Management - Days - Bayfront Hospital - St Petersburg

RN Care Manager, Acute

Title: RN Care Manager, Acute

Department: Case Management

Site: Bayfront Hospital

Location: St. Petersburg, FL

Shift: Day, Full-Time Schedule: 8am-4:30pm Mon-Fri with weekend rotations (up to 1-2 weekends per month) and holiday rotation

About Orlando Health Bayfront Hospital: Orlando Health Bayfront Hospital is a comprehensive tertiary care facility that has been serving St. Petersburg and the surrounding communities for more than 100 years. It is a 480-bed teaching medical center with nationally recognized care across emergency medicine, cardiology, neurosurgery, orthopedics, women's services, and advanced surgical specialties. The hospital's Level II Trauma Center is the only adult trauma center in Pinellas County and, in partnership with Johns Hopkins All Children's Hospital, is one of Florida's 13 state-certified Level III Regional Perinatal Intensive Care Centers. A commitment to quality has earned the hospital recognition with a USA Today Top Workplaces award for 2025 and an "A" Hospital Safety Grade from The Leapfrog Group. Orlando Health Bayfront Hospital is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida's east to west coasts. As part of the Orlando Health system, Bayfront combines the resources of a leading regional healthcare network with the personalized, community-focused care that has defined the hospital for generations. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions.

Why Orlando Health is your best place to work:

Education & Career Growth Assistance Comprehensive Health & Wellness coverage and resources Financial & Retirement Planning with Company Match Excellent Company Culture and WorkLife Balance Family & Pet Support

and more!

Job Description:

An RN Case Manager (RNCM) is a registered nurse responsible for coordinating patient care across the continuum, ensuring safe, efficient, and appropriate utilization of healthcare resources while maintaining a strong focus on quality outcomes.

The RNCM 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.

Core Responsibilities:

Care Coordination

• Assess patients upon admission for discharge planning needs
• Develop and implement individualized care transition plans
• Collaborate with physicians, nurses, social workers, therapists, and ancillary services
• Ensure smooth transitions to post-acute care (SNF, rehab, home health, hospice)
• Prevent avoidable delays in care or discharge
• Monitor length of stay (LOS) and address barriers early
• Participate in payer communication and authorization processes

Discharge Planning

• Identify social, financial, and clinical barriers
• Coordinate with families and caregivers
• Arrange services such as DME, home health, transportation, or community resources
• Ensure safe and timely discharge to the appropriate level of care

Patient & Family Advocacy

• Educate patients and families about care plans and options
• Promote informed decision-making
• Address Social Determinants of Health (SDOH) impacting recovery

Compliance & Documentation

• Maintain accurate documentation supporting medical necessity
• Ensure regulatory and accreditation standards are met
• Participate in quality improvement initiatives

Responsibilities

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 patient's 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 patient's 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 reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures
• 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.
• Performs other duties as assigned or required.

Qualifications

Education/Training:

• Graduate of an approved school of nursing.

Licensure/Certification:

• Must hold and maintain a current Florida RN license.

Experience:

• Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.