Orlando Health
RN Case Manager - Arnold Palmer Hospital, Neurology Specialty Practice - Downtow
Orlando Health, Orlando, Florida, United States, 32801
Position Summary Orlando Health Medical Group is a comprehensive physician group serving patients from across the southeastern United States. With more than 200 practices and 1,200 physicians, Orlando Health Medical Group has a strong representation in over 55 specialties, including cardiology, vascular medicine, orthopedics, oncology, digestive health, neurology, neurosurgery, bariatric surgery, general surgery, bone marrow transplant and critical care medicine, as well as more than 30 pediatric subspecialties, women's health, primary care and the largest hospitalist program in Florida. Orlando Health Medical Group 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 and beyond. Collectively, our 27,000+ 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. 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. 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. 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.
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.
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.