RN Care Manager – ED – Case Management – Winter Garden
Florida Hospital Winter Garden ED seeks to hire Care Manager who will embrace our mission to extend the healing ministry of Christ.
Florida Hospital Winter Garden is a state-of-the-art emergency facility featuring board-certified physicians trained in the care of both adults and children. The 97,415-square-foot, three-story facility opened in February 2016 across from Winter Garden Village at Fowler Groves. It is Florida Hospital's ninth campus in Central Florida. Outpatient imaging, lab, and surgical services, as well as primary care and specialty physician offices, are all available at one convenient location.
The Care Management Department is located in every campus throughout the Florida Hospital system. Our objective is to create a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for services to meet an individuals and family's comprehensive needs. Care Management is an integrated department with physicians, clinical/nursing teams, ancillary departments and the revenue cycle teams. Care management meets the needs of our patients, families and significant others throughout the care continuum including the post-discharge needs.
Under general supervision of the Director and/or Manager of Care Management, in collaboration with the patient/family, social workers, physicians and interdisciplinary team, the ED RN Care Manager provides guidance regarding admissions, status decisions, and level of care. The ED RN Care Manager, in a team approach with the ED Social Worker/ED staff, assists with identification of readmissions, patients with potential needs for community resources or potential post-acute needs. Education is provided to physicians and other members of the clinical team on issues related to utilization review including appropriateness of admissions and level of care. The ED RN Care Manager complies with Care Management departmental goals, objectives, and policies and procedures, and supports the Florida Hospital mission. The ED RN Care Manager actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Ability to communicate effectively with diverse populations
Ability to function in a stressful and fast-paced environment
Interpersonal skills that promote teamwork
Critical thinking and problem-solving skills
Knowledge of and ability to utilize in-house and external resources
Flexibility in prioritization
Ability to multitask
Effective organizational skills
Minimum of five years recent acute care experience
Superior clinical skills to determine appropriate clinical and other information for medical necessity reviews and identify appropriate mechanism to address delays or variation for expected care practices. (Preferred)
Significant knowledge and understanding of availability of community and post-acute resources and related payer requirements. (Preferred)
Master's degree in Nursing (Preferred)
Minimum of two years of experience in the ED (Preferred)
Minimum of two years of utilization review/case management experience and a minimum of one year of experience in discharge planning in an acute care setting highly desirable.(Preferred)
Licensure, Certification, or Registration Required:
Clear/Active Florida State license as a Registered Nurse
Case Management certification highly desirable – ACM (Accredited Case Manager), CCM (Certified Case Manager), RN-BC (Board Certified in Case Management) (Preferred)
Demonstrates through behavior Florida Hospital's Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization's Performance Excellence Program
Conducts clinical review using specific indicators and criteria in accordance with regulatory and contractual requirements. Uses established medical necessity criteria as described by policy to conduct screening for medically appropriate admissions and level of care determinations. Escalates cases as appropriate to Care Management Director/Manager. Utilizes information obtained from information systems to accurately assess patient clinical needs and treatment if available and appropriate.
Provides updates to the ED clinical team regarding Care Management involvement with the patient during the patient's visit.
Works as a resource to the ED clinical team as needed.
Acts as a resource and provides staff and physician education related to resource utilization, medical necessity, and federal regulation and guidelines.
Works with the ED team to achieve optimal patient flow/throughput to enhance continuity of care, smooth and safe transition, patient satisfaction, and patient safety.
Communicates effectively with physicians to obtain necessary information to complete all medical necessity reviews as required to prevent unnecessary delays and denials of service. Participates with the healthcare team regarding the patient's treatment plan; may communicate with patient/family as needed.
Refers to the Social Worker for follow-up as needed.
Responds to processes to identify patients with frequent ED visits and/or readmissions to maintain and enhance the plan of care.
Utilizes thorough knowledge of various computer/information systems to perform assigned duties.
Documents activities, including utilization review activities, statistics, clinical assessments and plans in a thorough and timely manner or per Care Management Department policy.
Thoroughly and efficiently provides information through documentation for continuity of care.
Performs other duties as assigned by Care Management leadership.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Care Manager opportunity with Florida Hospital Winter Garden ED and apply online today.
Florida Hospital is dedicated to improving lives not only in Central Florida, but also around the world. As a destination hospital, we are committed to serving the health care needs of our patients with a holistic approach to heal the mind, body and spirit. We strive to be the hospital of choice for patients, physicians and employees. Over the last 100 years, Florida Hospital’s mission remains unchanged: to extend the healing ministry of Christ.