RN Care Manager- Horizon West Case Management- Part Time- Weekend Days

Job description

Position Summary
ORLANDO HEALTH HORIZON WEST HOSPITAL
Orlando Health Horizon West Hospital is a 60-bed acute-care hospital – with room to grow to 120-beds – located in
the Horizon West community of Winter Garden, Florida. The facility offers a full complement of services, including
heart care with complete cardio-diagnostic capabilities, digestive health, emergency care, outpatient imaging and
lab, orthopedics and sports medicine, and reflux and esophageal disorders. Advanced surgical services include
minimally invasive and robotic surgery options with specialty in general, thoracic, podiatric, orthopedic and
advanced gynecologic procedures. The hospital has earned Primary Stroke Center and Joint Replacement
certification from The Joint Commission and a repeat “A” Safety Grade from The Leapfrog Group for Spring 2025.
Orlando Health Horizon West 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
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.
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 implement strategies for improvement.
• Forwards identified quality and/or risk issues appropriately.
• Maintains positive relationships with outside/onsite reviewers and other payer representatives.
• Identifies cultural, socio-economic, religious, and other factors that may impact treatment.
• Involves patient’s family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family.
• Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members.
• Prioritizes workload to manage multiple priorities while using problem-solving skills to meet goals.
• Enhances professional growth by participating in educational programs, current literature and/or workshops.
• Possesses excellent interpersonal skills and ability to work in a team environment.
• Respects the rights and privacy of others and holds staff member information in strict confidence.
• 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.
• 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.

Schedule
Saturday/Sunday/Wednesday
Responsibilities
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.
Qualifications
Education/Training
Graduate of an approved school of nursing.
Licensure/Certification
Maintains current Florida RN license.
BLS/Healthcare Provider Certification
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.