Strive to provide excellence in service to hospital staff, patients and families.
Consistently utilize five fundamentals of AIDET Acknowledge, Introduce, Duration, Explanation, Thank you.
Committed to working as a team to improve employee satisfaction and engagement scores.
Demonstrate care for one another and respect for each personâ™s unique contributions.
Provides utilization review care that is non-judgmental and non-discriminatory.
Demonstrates respect for human dignity and self-worth.
Respects patient privacy, confidentiality, and dignity by adherence to all HIPAA regulations.
Maintains a professional appearance and manner.
Consider factors related to patient safety, effectiveness, cost and impact on practice in the delivery of Case Management services. Strives to reduce Medicare and ALOS below established benchmarks.
Assess appropriateness of setting as indicated for medical necessity according to the approved InterQual ISD criteria. Initial and concurrent clinical reviews contain needed elements to sufficiently support.
Utilizes InterQualÂ®ISD criteria to ensure appropriate level of care settings.
Passes Annual Inter-Rater reliability testing for InterQualÂ®.
Apply appropriate Inpatient, Observation or Outpatient in a bed admission status.
Screens for lowest level of safe care and initiate referrals and communication with HHC, ALF, DME, SNF, Insurance providers.
Provide information to patients and families for resources in the community for care, financial assistance etc.
Strives to reduce the Medicare & ALOS to below established benchmarks.
Strives to reduce the number of observation cases and the number of hours patients remain in observation status.
Ensures appropriate referral of cases for second level review.
Documents in approved EHR and electronic tools to ensure information for data collection and productivity.
Facilitates staff and physicians to utilize Core Measure order sets and protocols.
Educates physicians and staff on community resources when needed.
Identifies and updates current information on community resources.
Maintains knowledge of current managed care contracts, federal statutes, regulations and procedures and applies them in performance of review activities.
Enhances professional knowledge and development through participation in educational programs and in-service meetings. Stays current with journal articles etc.
Completes annual mandatory education.
Honor's patient's rights by following privacy guidelines and code of ethics
Demonstrates honesty and fairness in all actions and behaviors and accepts accountability for ones actions.
Recognize and anticipate the needs of others and go beyond their job to exceed expectations of those we serve.
Greets everyone they encounter with a smile, using caring tone during conversations, and makes frequent and appropriate eye contact.
Use common courtesy practices such as helping lost individuals, saying please and thank you, and knocking on a patientâ™s door before entering.
Proactively support a culture of safety and quality.
Listen respectfully and avoid defensiveness in verbal and non-verbal communication. Exhibit willingness to assist co-workers.
Display support in organizational decisions in their communication and actions.
Refrains from gossiping and spreading rumors.
Looks for opportunities to support, recognize and celebrate teamwork.
What You Will Need:
Graduate of an accredited School of Nursing, Specific Degree/Major: Nursing
Current license of registered nurse in Florida or licensure from another state with verification of application of eligibility for Florida licensure by endorsement
Application of InterQualÂ® Criteria set.
Assessment competency and knowledge application for all ages from newborn to geriatric.
Assessment competency for appropriate use of hospital services and care coordination.
EDUCATION AND EXPERIENCE PREFERRED:
Greater than three yearsâ™ experience in healthcare
Case Management Certification
Any combination of education, training or experience that provides the knowledge, skills and abilities required to successfully accomplish the assigned duties and responsibilities of the position.
One year acute-care nursing, charge nurse, emergency department, or crucial care nursing experienced.
The Case Manager is accountable for the organization, to facilitate the flow of patients to the next site (level) of care including inpatient acute care, community services or transfer to another facility/campus, sequence of services and resources that are necessary and appropriate for the achievement of patient care outcomes within effective time frames on a specific group of patients. In addition, the Case Manager will coordinate the plan of care among all members of the health care team. The Case Manager must have the professional ability to practice under minimal supervision and perform the following seven essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation, with emphasis on decreasing length of stay and monitoring cost effective health care across the continuum of care. The Case Manager must continually review the patient to facilitate status, patient needs with the appropriate level and type of medical, psychosocial, or social service as they relate across the continuum of care. The Case Manager evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the caseload according to Case Management Department Plan, policies and procedures.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.
What Information Do We Collect?
When you visit our website you may provide us with two types of information: personal information you knowingly choose to disclose that is collected on an individual basis and website use information collected on an aggregate basis as you and others browse our website.
Personal Information You Choose to Provide
We may request that you voluntarily supply us with personal information, including your email address, postal address, home or work telephone number and other personal information for such purposes as correspondence, placing an order, requesting an estimate, or participating in online surveys.
If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
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Broadly speaking, we use personal information for purposes of administering our business activities, providing service and support and making available other products and services to our customers and prospective customers. Occasionally, we may also use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. The lists used to send you product and service offers are developed and managed under our traditional standards designed to safeguard the security and privacy of all personal information provided by our users. You may at any time to notify us of your desire not to receive these offers.
What Are Cookies?
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How Do We Use Information Collected From Cookies?
We use website browser software tools such as cookies and web server logs to gather information about our website users' browsing activities, in order to constantly improve our website and better serve our users. This information assists us to design and arrange our web pages in the most user-friendly manner and to continually improve our website to better meet the needs of our users and prospective users.
Cookies help us collect important business and technical statistics. The information in the cookies lets us trace the paths followed by users to our website as they move from one page to another. Web server logs allow us to count how many people visit our website and evaluate our website's visitor capacity. We do not use these technologies to capture your individual email address or any personally identifying information about you.
Notice of New Services and Changes
Occasionally, we may use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. As a user of our website, you will be given the opportunity to notify us of your desire not to receive these offers by clicking on a response box when you receive such an offer or by sending us an email request.
How Do We Secure Information Transmissions?
When you send confidential personal information to us on our website, a secure server software which we have licensed encrypts all information you input before it is sent to us. The information is scrambled en route and decoded once it reaches our website.
Other email that you may send to us may not be secure unless we advise you that security measures will be in place prior to your transmitting the information. For that reason, we ask that you do not send confidential information such as Social Security, credit card, or account numbers to us through an unsecured email.
How Do We Protect Your Information?
Information Security -- We utilize encryption/security software to safeguard the confidentiality of personal information we collect from unauthorized access or disclosure and accidental loss, alteration or destruction.
Evaluation of Information Protection Practices -- Periodically, our operations and business practices are reviewed for compliance with organization policies and procedures governing the security, confidentiality and quality of our information.
Employee Access, Training and Expectations -- Our organization values, ethical standards, policies and practices are committed to the protection of user information. In general, our business practices limit employee access to confidential information, and limit the use and disclosure of such information to authorized persons, processes and transactions.
How Can You Access and Correct Your Information?
You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us using the contact form provided to you within the site structure of our website.
Do We Disclose Information to Outside Parties?
What About Legally Compelled Disclosure of Information?
We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights.
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