RN Care Manager — Care Coordination & Transitions

Orlando Health, Inc.; Orlando (FL); On-site; USD 70,000 - 95,000; Full time

Job summary

Orlando Health, Inc. seeks an experienced nurse to oversee care coordination from admission to discharge, working with the clinical team to identify patients who will benefit from coordinated care.

You will assess risk factors, support transitions, and manage utilization and length of stay while aligning with InterQual guidelines. Key duties include leading multidisciplinary conferences, making referrals, communicating plans to patients and families, and ensuring regulatory compliance.

Qualifications

• Graduate of an approved school of nursing.
• Three 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 required for Behavioral Health Unit within 90 days of hire.

Responsibilities

• Assess patients within assigned population with medical history, current treatments, and anticipated needs.
• Screen for medical necessity and submit for Physician Advisor review.
• Coordinate care, including admission diagnosis, age, resources, and discharge planning.
• Assign initial DRG to determine GMLOS and monitor LOS and transitions per InterQual guidelines.
• Lead multi-disciplinary patient care conferences and Complex Case Review.
• Refer complex patients to Social Work; communicate plan of care to patients and families.
• Ensure compliance with regulatory standards and Utilization Management Plan.
• Educate physicians, patients, families, and caregivers; interact with third-party payers.
• Prioritize high-risk areas and monitor data to drive improvements.

Skills

Organizational skills

Verbal communication

Written communication

Leadership

Critical thinking

Problem solving

Computer literacy

Education

Florida RN license

Job description

Orlando Health, Inc. seeks an experienced nurse to oversee care coordination from admission to discharge, working with the clinical team to identify patients who will benefit from coordinated care.

You will assess risk factors, support transitions, and manage utilization and length of stay while aligning with InterQual guidelines. Key duties include leading multidisciplinary conferences, making referrals, communicating plans to patients and families, and ensuring regulatory compliance.