RN Care Manager: Care Coordination & Utilization

Orlando Health; Orlando (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

Orlando Health is seeking a Care Coordination Specialist to optimize hospital resources from admission to discharge, collaborating with the clinical team to identify patients who will benefit from care coordination and utilization management.

This role involves accurate medical necessity screening, DRG assignment, LOS and transition planning, leading multi-disciplinary conferences, referrals, and patient-family communications to ensure compliant, quality care.

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 within 90 days of hire. The training will be provided onsite.

Responsibilities

• Accurate medical necessity screening and submission for Physician Advisor review.
• Care coordination including admitting diagnosis, medical history, current treatments, and anticipated needs.
• Assignment of initial DRG to determine GMLOS; monitor LOS and transition planning per InterQual guidelines.
• Lead and facilitate multi-disciplinary patient care conferences.
• Refer complex patients to Social Work Services and other departments.
• Communicate plan of care with patients and families.
• Lead and participate in Complex Case Review and quality/risk issue reporting.

Skills

Organizational skills

Verbal and written communication

Leadership and coordination

Critical thinking and problem-solving

Computer literacy

Education

Nursing degree (RN)

Tools

EHR navigation

Job description

Orlando Health is seeking a Care Coordination Specialist to optimize hospital resources from admission to discharge, collaborating with the clinical team to identify patients who will benefit from care coordination and utilization management.

This role involves accurate medical necessity screening, DRG assignment, LOS and transition planning, leading multi-disciplinary conferences, referrals, and patient-family communications to ensure compliant, quality care.