RN Care Manager

Where You’ll Work (and Why You’ll Love It!) Orlando Health Advanced Rehabilitation Institute offers comprehensive CARF-accredited inpatient and outpatient rehabilitation programs for adults, adolescents and children, with specialty programs in stroke, spinal cord and brain injury rehabilitation. A dedicated 54-bed rehabilitation hospital provides post-acute care for patients requiring medical and intensive rehabilitative therapies covering a full range of orthopedic and neurological conditions. The facility has all-private rooms, three therapy gyms outfitted with the latest technology (e.g., weight-assisted treadmill, robotics for training in arm/hand coordination and walking, and communication-assistance technology), a simulated apartment, and an expansive outdoor space for additional therapeutic activity. Outpatient centers feature interdisciplinary teams working together to help each patient meet their individual rehabilitation goals and achieve the highest possible level of independence. A Day in YOUR Life as a RN 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. Schedule: Full-Time 8:00am-4:30pm Responsibilities Initially and concurrently assesses all patients within assigned population 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 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 regular attendance and complies with time and attendance policy and procedures. Adheres to Orlando Health’s 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. 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. Required Qualifications Education/Training Graduate of an approved school of nursing. Licensure/Certification Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Benefits Beyond the Expected 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. “Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you. Benefits that begin on Day 1 Four (4) weeks paid parental leave Debt-free degrees through our Preferred Education Program Tuition reimbursement and loan repayment programs The Orlando Health System of Care 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, Central Alabama and Puerto Rico. Collectively, our dedicated team members honor our over 100-year legacy by providing professional and compassionate care to the patients, families and communities we serve. Join us! #J-18808-Ljbffr