Registered Nurse (RN) - Care Manager
Health Central Hospital
Ocoee, FL

Care Manager - Advanced Rehab (Ocoee)

Position Summary The Orlando Health Advanced Rehabilitation Institute is a world-class provider of specialty rehabilitation services for patients 12 and older. Our team includes physicians and therapists dedicated to helping you overcome complications related to stroke, brain injuries, spinal injuries, amputations and other conditions that affects your quality of life and independence. Our patients directly benefit from Orlando Health's network of services, including specialized physicians, state-of-the-art equipment, diagnostic services and treatment options not available at other rehabilitation centers. Our relationship with Orlando Health Orlando Regional Medical Center, the area's only Level One Trauma Center, means our rehabilitation specialists can begin working with you from the moment you enter our emergency department. We offer some of the most advanced technology available to assist you on your recovery, including: * Aretech ZeroG for treadmill training * Lite Gait Supported Gait and Safety System * Armeo robotics for arm training * Pressure mapping systems * Virtual reality training * Restorative Therapies RT300 and Xcite Integrated Functional Electrical Stimulation systems Our goal is to improve the health and quality of life of the people and communities we serve. From that goal comes our purpose statement: "Through interdisciplinary rehabilitation we will relieve, restore and reintegrate." Top Reasons to Work at Orlando Health Forbes has named Orlando Health as one of America's Best-In-State Employers. 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. Job Summary: The Care Manager - Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient 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. Responsibilities 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. 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. 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. 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.