RN Care Manager - Per Diem Days

Orlando Health Melbourne Hospital

Orlando Health Melbourne Hospital is a comprehensive medical and surgical acute care facility serving the Brevard County Space Coast as a trusted healthcare provider since 2002. Conveniently located in Melbourne, the 119-bed hospital has all private rooms and is uniquely designed for your comfort and a positive patient experience. Our dedicated team of physicians, nurses, clinicians and medical professionals is committed to delivering the highest level of quality and compassionate care. We provide a complete scope of care, with advanced technology and expertise in a number of specialties, including cardiovascular care, digestive health, emergency care, orthopedics and surgical services. Recognized for high standards, we have earned full hospital and laboratory accreditation from The Joint Commission, and we are the first hospital in Brevard County to receive spine surgery certification for our specialized spine program.

The Joint Commission's Gold Seal of Approval distinguishes healthcare organizations and programs that exemplify their commitment to using best practices to improve safety and quality for their patients, staff and community. As part of our commitment to quality care, we also are a participant in the American College of Cardiology CathPCI Registry for improved diagnostic cardiac catheterizations and percutaneous coronary interventions for heart patients.

Competitive Pay Evening, nights, and weekend shift differentials offered for qualifying positions. All inclusive benefits (starting on day one) student loan repayment, tuition reimbursement, free college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/holidays, and more for full time and part time employees. Employee-centric Orlando Health has been selected as one of the "Top Places to Work in Healthcare" by Becker's Healthcare. Company is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

Responsibilities

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

Graduate of an approved school of nursing. Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. 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.