* Uses established medical necessity criteria as described by policy to conduct screening for medically appropriate admissions. 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 and/or Observation clinical team regarding Care Management involvement with the patient during the patient’s visit.
* Works as a resource to the ED and/or Observation 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 and/or Observation 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 and may assist 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 clinical assessments and discharge 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.
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/Observation RN Care Manager provides guidance regarding admissions. The ED/Observation 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. The ED/Observation RN Care Manager complies with Care Management departmental goals, objectives, and policies and procedures, and supports the AdventHealth mission. The ED/Observation RN Care Manager actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all
What you will need:
KNOWLEDGE AND SKILLS REQUIRED:
· 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
· Proficiency in the daily use of standard office equipment such as computer, phone, fax, pager, copier etc. and skill in utilizing Microsoft Word and Outlook tools
KNOWLEDGE AND SKILLS PREFERRED:
· 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
EDUCATION AND EXPERIENCE REQUIRED:
· Three years recent acute care experience
· Associate Degree in Nursing
EDUCATION AND EXPERIENCE PREFERRED:
· Bachelor’s degree in Nursing
· Minimum of two years of experience in the ED
· 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
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:
· Current valid State of Florida or multi state license as a Registered Nurse
LICENSURE, CERTIFICATION, OR REGISTRATION PREFERRED:
· Case Management certification– ACM (Accredited Case Manager), CCM (Certified Case Manager), RN-BC (Board Certified in Case Management)
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.
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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.
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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.
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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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