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

RN Care Manager, Acute

Position Overview:

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.

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.

• Care Coordination
• Discharge Planning
• Patient & Family Advocacy
• Compliance & Documentation

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.

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 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,…