RN - Care Coordination- Care Management Team- Days - Med Surg

Company: Orlando Health
Location: Orlando
Posted on: March 19, 2023

Job Description:

RN - Care Coordination- Care Management Team- DaysPosition Summary

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. This is an Acute Care RN position located at the Dr. Philllips location.

Qualifications

Education/Training

Graduate of an approved school of nursing.

Licensure/Certification

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.

Responsibilities

Initially and concurrently assesses all patients within assigned population to include, but not limited to:

o Accurate medical necessity screening and submission for Physician Advisor review

o 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.

o 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.

o Leading and facilitating multi-disciplinary patient care conferences

o Managing concurrent disputes

o Making appropriate referrals to other departments

o Identifying and referring complex patients to Social Work Services

o Communicating with patients and families about the plan of care

o Leading and facilitating Complex Case Review

o Identification and documentation of potentially avoidable days

o Identification and reporting over and underutilization

Education/Training

Graduate of an approved school of nursing.

Licensure/Certification

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.

Initially and concurrently assesses all patients within assigned population to include, but not limited to:

o Accurate medical necessity screening and submission for Physician Advisor review

o 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.

o 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.

o Leading and facilitating multi-disciplinary patient care conferences

o Managing concurrent disputes

o Making appropriate referrals to other departments

o Identifying and referring complex patients to Social Work Services

o Communicating with patients and families about the plan of care

o Leading and facilitating Complex Case Review

o Identification and documentation of potentially avoidable days

o Identification and reporting over and underutilization

Keywords: Orlando Health, Orlando , RN - Care Coordination- Care Management Team- Days - Med Surg, Healthcare , Orlando, Florida