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RN Care Manager
4 months ago
Position Summary The Registered Nurse Care Manager promotes and facilitate 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. Orlando Health ORMC is the flagship hospital of the Orlando Health system of care, which includes 24 award-winning hospitals and ERs, 9 specialty institutes, 14 urgent care centers, 100+ primary care practices and more than 60 outpatient facilities that span Florida's east to west coasts and beyond. Collectively, we provide care for more than 142,000 inpatient and 3.9 million outpatient visits each year. 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. Responsibilities * 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. * 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. Qualifications Education Graduate of an approved school of nursing. Licensure Maintains current Florida RN license and BLS/Healthcare Provider certification are required. BLS/Healthcare Provider Certification within 90 days of hire. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care Education Graduate of an approved school of nursing. Licensure Maintains current Florida RN license and BLS/Healthcare Provider certification are required. BLS/Healthcare Provider Certification within 90 days of hire. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care * 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. * 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.
