Registered Nurse - Care Manager

Position SummaryPosition SummaryPromotes 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:Accurate medical necessity screening and submission for Physician Advisor reviewCare 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 othern 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 conferencesManaging concurrent disputesMaking appropriate referrals to other departmentsIdentifying and referring complex patients to Social Work ServicesCommunicating with patients and families about the plan of careLeading and facilitating Complex Case ReviewIdentification and documentation of potentially avoidable daysIdentification and reporting over and underutilizationQualificationsEducation/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.ExperienceThree (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acuteclinical care.