RN Care Manager- Health Central Case Management- Part Time- Days presso Orlando Health

ORLANDO HEALTH – HEALTH CENTRAL HOSPITAL
Located in Ocoee, Florida, Orlando Health – Health Central Hospital is a 252-bed comprehensive medical and
surgical acute-care facility that has been serving the residents of west Orange County for more than 70 years.
Services range from 24/7 emergency care to cardiovascular and stroke care, neurosciences, oncology, orthopedics,
minimally invasive robotic surgery and more. Our hospital has accreditations and designations in many specialty
services, including bariatric surgery, spine surgery, stroke, and hip and knee joint replacement. We also have earned
2024-25 High Performing Hospital ratings in five areas – COPD, diabetes, heart attack, heart failure and hip
replacement – from U.S. News & World Report, and 2024 Top Teaching Hospital recognition from The Leapfrog Group.

Orlando Health – Health Central is part of the Orlando Health system of care, which includes award-winning hospitals
and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida’s
east to west coasts, Central Alabama and Puerto Rico. Collectively, our team members honor our over 100-year
legacy by providing professional and compassionate care to the patients, families and communities we serve.

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE
education programs and well-being services to support you and your family through every stage of life. We begin
your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions.
“Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you.

Position 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.

Essential Functions
• 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
• 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:
o Utilization Management supporting medical necessity and denial prevention
o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level
of care
o 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.

Other Related Functions
• Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining
confidentiality of data and patient information.
• Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of
relevant reimbursement information.
• Actively serves on committees and task forces to promote quality, cost-effective care for patient population.
• Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy.
• Performs other duties as assigned or required.

Education/Training
• Graduate of an approved school of nursing.

Licensure/Certification
• Must hold and maintain a current Florida RN license.
• Handle with Care (HWC) Certification is required for the Behavioral Health Unit within 90 days of hire. The Handle with Care
training and education will be provided onsite to all team members.

Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.