RN Care Manager

Position Summary

Orlando Health Is Your Best Place to Work is not just something we say, it’s our promise to you.

About Orlando Health Sebastian River Hospital:
Orlando Health Sebastian River Hospital is a 178-bed comprehensive medical and surgical facility serving the communities along Florida’s Treasure Coast as a trusted healthcare provider for more than 50 years. With the latest technology and a team of skilled healthcare professionals, we are committed to bringing the highest level of expert and compassionate care to the communities we serve.

With a full scope of care, we offer advanced technology and expertise in a number of specialties, including emergency care, heart and vascular care, orthopedics and surgical services. Recognized for high standards, we have earned full hospital and laboratory accreditation from The Joint Commission, as well as advanced certification as a Primary Stroke Center for our high-quality stroke care. As further demonstration of our commitment to quality and safety, we have earned several additional industry recognitions.

to Learn More About:
Sebastian River Hospital

Evening, nights, and weekend shift differentials offered for qualifying positions.

Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, backup elder and childcare, pet insurance, PTO/Holidays, and more for full-time and part-time employees.

Orlando Health has been selected as one of the “Top Places to Work in Healthcare” by Becker’s Healthcare.

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.

• 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 and reassessment and the application of Inter Qual 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 under utilization
• 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,…