RN Case Manager - Case Management
Company: Orlando Health
Location: Orlando
Posted on: March 19, 2023
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Job Description:
RN Case ManagerPosition Summary
Promotes and facilitates effective use of hospital resources.
Assists with planning an individual comprehensive case management
plan addressing patient/family needs and transition to the next
appropriate level of care.
Qualifications
Education/Training
Must have one of the following to be in this role:
o Bachelor of Science in Nursing degree (BSN)
o Associate of Science in Nursing (ASN)
o Be a Diploma Nurse with 5 or more years of applicable/related
experience.
Licensure/Certification
* Maintains license as an RN in the State of Florida.
* Maintains current BLS/ healthcare provider certification.
Experience
Three (3) years of experience in chronic disease management, case
management, utilization management, or acute clinical care.
Responsibilities
Essential Functions
Initially and concurrently assesses all patients within assigned
population to include but not limited to admitting
diagnosis/medical history, current treatments/therapies, age,
payment source, criteria compliance, resources, support systems,
anticipated needs,
expected length of stay, appropriate level of service,
special/personal needs, and other relevant information.
Assigns working DRG and GMLOS, while concurrently monitoring and
managing LOS, as appropriate (determined by medical necessity using
Interqual guidelines).
Develops collaborative relationships with patient/family, patient
business, nursing staff/leadership, physicians, social workers,
care coordinators, and ancillary services to facilitate optimal
patient outcomes and efficient movement through the continuum of
care.
Prioritizes activities in assigned areas to focus on high risk,
high cost, and problem prone areas.
Acts as an advocate for patient's health care needs.
Performs admission and concurrent utilization review in compliance
with review requirements for Managed Care contracts, governmental
payors (i.e. Medicare, Medicaid, and Champus) and departmental
review policies; adheres to Utilization Management Plan.
Communicates in an appropriate and timely manner with
interdisciplinary team to coordinate/evaluate plan of care.
Communicates with third party payers and external care team as
appropriate/necessary.
Monitors and evaluates data, fiscal outcomes, and other relevant
information to develop and implement strategies for process
improvements related to case management activities.
Maintains positive relationships with peers, collaborative team,
outside reviewers, and post-acute providers.
Maintains reasonably regular, punctual attendance consistent with
Orlando Health policies, the ADA, FMLA, and other federal, state,
and local standards.
Maintains compliance with all Orlando Health policies and
procedures.
Other Related Functions
Demonstrates awareness of medical/ legal issues, patient rights and
compliance with standards of regulatory and accrediting
agencies.
Serves as a facilitator to physician, nursing staff/leadership and
ancillary services (physical therapy, respiratory therapy, clinical
social work, care coordination, etc.).
Maintains records and documentation of work performed in a timely,
organized, and easily retrievable fashion.
Reviews current literature on a regular basis; stays current on
changes in policies/procedures, maintains reference materials and
updates as required, and keeps abreast of relevant reimbursement
information.
Assumes responsibility as a self-directed professional for ongoing
education, based on individual identified needs.
Actively serves on committees and task force teams to promote
quality, cost-effective care for patient population.
Maintains positive relationships with outside reviewers and other
payer representatives.
Forwards identified quality and/or risk issues to appropriate
person.
Education/Training
Must have one of the following to be in this role:
o Bachelor of Science in Nursing degree (BSN)
o Associate of Science in Nursing (ASN)
o Be a Diploma Nurse with 5 or more years of applicable/related
experience.
Licensure/Certification
* Maintains license as an RN in the State of Florida.
* Maintains current BLS/ healthcare provider certification.
Experience
Three (3) years of experience in chronic disease management, case
management, utilization management, or acute clinical care.
Essential Functions
Initially and concurrently assesses all patients within assigned
population to include but not limited to admitting
diagnosis/medical history, current treatments/therapies, age,
payment source, criteria compliance, resources, support systems,
anticipated needs,
expected length of stay, appropriate level of service,
special/personal needs, and other relevant information.
Assigns working DRG and GMLOS, while concurrently monitoring and
managing LOS, as appropriate (determined by medical necessity using
Interqual guidelines).
Develops collaborative relationships with patient/family, patient
business, nursing staff/leadership, physicians, social workers,
care coordinators, and ancillary services to facilitate optimal
patient outcomes and efficient movement through the continuum of
care.
Prioritizes activities in assigned areas to focus on high risk,
high cost, and problem prone areas.
Acts as an advocate for patient's health care needs.
Performs admission and concurrent utilization review in compliance
with review requirements for Managed Care contracts, governmental
payors (i.e. Medicare, Medicaid, and Champus) and departmental
review policies; adheres to Utilization Management Plan.
Communicates in an appropriate and timely manner with
interdisciplinary team to coordinate/evaluate plan of care.
Communicates with third party payers and external care team as
appropriate/necessary.
Monitors and evaluates data, fiscal outcomes, and other relevant
information to develop and implement strategies for process
improvements related to case management activities.
Maintains positive relationships with peers, collaborative team,
outside reviewers, and post-acute providers.
Maintains reasonably regular, punctual attendance consistent with
Orlando Health policies, the ADA, FMLA, and other federal, state,
and local standards.
Maintains compliance with all Orlando Health policies and
procedures.
Other Related Functions
Demonstrates awareness of medical/ legal issues, patient rights and
compliance with standards of regulatory and accrediting
agencies.
Serves as a facilitator to physician, nursing staff/leadership and
ancillary services (physical therapy, respiratory therapy, clinical
social work, care coordination, etc.).
Maintains records and documentation of work performed in a timely,
organized, and easily retrievable fashion.
Reviews current literature on a regular basis; stays current on
changes in policies/procedures, maintains reference materials and
updates as required, and keeps abreast of relevant reimbursement
information.
Assumes responsibility as a self-directed professional for ongoing
education, based on individual identified needs.
Actively serves on committees and task force teams to promote
quality, cost-effective care for patient population.
Maintains positive relationships with outside reviewers and other
payer representatives.
Forwards identified quality and/or risk issues to appropriate
person.
Keywords: Orlando Health, Orlando , RN Case Manager - Case Management, Healthcare , Orlando, Florida
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