RN Care Manager - Per Diem Days

Orlando Health, Inc.; Orlando (FL); On-site; USD 90,000 - 130,000; Full time

Job summary

Orlando Health Melbourne Hospital seeks a care coordination professional to manage patient transitions, utilization, and clinical pathways within assigned populations. The role emphasizes accurate medical necessity screening, DRG assignment, and collaboration with multidisciplinary teams.

You will lead and participate in care conferences, ensure regulatory compliance, and work with physicians, social work, and payers to optimize length of stay and patient outcomes.

Responsibilities

• 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, including admitting diagnosis, medical history, current treatments, age, resources and needs.
• Assign initial DRG to determine GMLOS; monitor LOS and plan transitions with InterQual guidelines.
• Lead and facilitate multi-disciplinary patient care conferences.
• Manage concurrent disputes.
• Refer complex patients to Social Work and other departments.
• Communicate with patients and families about the plan of care.
• Lead and facilitate Complex Case Review.
• Identify and document potentially avoidable days.
• Identify and report over and underutilization.
• Ensure regulatory compliance (Federal, State, Local, Joint Commission) for admission and continued stay approvals.
• Adhere to Utilization Management Plan.
• Integrate national standards for care management scope of services.
• Utilization Management supporting medical necessity and denial prevention.
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction.
• Care coordination to ensure efficient throughput and proper level of care.
• Education provided to physicians, patients, families, and caregivers.
• Communicates appropriately and timely with the interdisciplinary team and third-party payers.
• Prioritize activities in assigned areas to focus on high risk, high cost, and problem prone areas.
• Develop collaborative relationships with care teams to facilitate flow.
• Monitor and evaluate data, fiscal outcomes, and other relevant information.

Job description

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 Melbourne Hospital

Orlando Health Melbourne Hospital is a comprehensive medical and surgical acute care facility serving the Brevard County Space Coast as a trusted healthcare provider since 2002. Conveniently located in Melbourne, the 119-bed hospital has all private rooms and is uniquely designed for your comfort and a positive patient experience. Our dedicated team of physicians, nurses, clinicians and medical professionals is committed to delivering the highest level of quality and compassionate care.

We provide a complete scope of care, with advanced technology and expertise in a number of specialties, including cardiovascular care, digestive health, emergency care, orthopedics and surgical services. Recognized for high standards, we have earned full hospital and laboratory accreditation from The Joint Commission, and we are the first hospital in Brevard County to receive spine surgery certification for our specialized spine program. The Joint Commission's Gold Seal of Approval distinguishes healthcare organizations and programs that exemplify their commitment to using best practices to improve safety and quality for their patients, staff and community. As part of our commitment to quality care, we also are a participant in the American College of Cardiology CathPCI Registry for improved diagnostic cardiac catheterizations and percutaneous coronary interventions for heart patients.

WHY ORLANDO HEALTH?

Competitive Pay

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

All Inclusive Benefits (Starting On Day One)

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

Employee-centric

Orlando Health has been selected as one of the \"Top Places to Work in Healthcare\" by Becker's Healthcare.

Company is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview

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.

Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be a part of a work family that values collaboration, innovation and dedication, we're the right company for you.

Section 1557 Non-Discrimination

The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 42 U.S.C. 18116.

Responsibilities

What you will do

• 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 InterQual 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 underutilization.
• 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, 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