Care Manager, Pool/PRN - Wiregrass Ranch Hospital, Wesley Chapel, FL

Position Summary Site: FMCOH Wiregrass Ranch Hospital Location: Wesley Chapel, Florida Position: RN Care Manager Department: Care Management Shift: Pool/PRN Elevating Healthcare in Wesley Chapel and West Florida, Florida Medical Clinic Orlando Health Wiregrass Ranch Hospital is poised to revolutionize healthcare in Wesley Chapel and the broader West Florida region. This five-story, state-of-the-art multi-specialty hospital spans 380,000 square feet, purpose-built to serve one of Florida’s fastest-growing communities with exceptional, outcomes-focused care. Designed for Excellence : Opening with 102 beds, expandable to 300 beds at full build-out 9 advanced operating rooms, including a hybrid OR with real-time imaging capabilities Comprehensive services in cardiology, neurology, oncology, surgery, and more 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, assess patients’ risk factors, support clinical utilization management, and oversee transitions to the next appropriate level of care. Responsibilities Initially and concurrently assess 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, reassessment, and 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 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 ensuring 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 patients, business, nursing, physicians, and families 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’ families in the development of the treatment plan, explaining procedures, therapies, system treatment plans, and discharge plans in age/developmental/educational specific terms to patients/families Reviews patients’ discharge plans 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 Health’s policies and procedures, Mission, Vision, Values statement, and Code of Conduct Qualifications 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 #J-18808-Ljbffr Florida Medical Clinic