- Location: ORMC At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities that span Florida’s east to west coasts and beyond. ORLANDO HEALTH - BENEFITS & PERKS: All Inclusive Benefits (start day one) Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees. Forbes Recognizes Orlando Health as a Best
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- State Employer Forbes has named Orlando Health as one of America's Best
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- State Employers for 2024. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued. Employee-centric Orlando Health has been selected as one of the “Best Places to Work in Healthcare” by Modern Healthcare
Promotes 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. Responsibilities
Initially and concurrently assesses all patients within assigned population to include, but not limited to: ◦ Accurate medical necessity screening and submission for Physician Advisor review. ◦ 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. ◦ 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 conferences. ◦ Managing concurrent disputes. ◦ Making appropriate referrals to other departments Identifying and referring complex patients to Social Work Services. ◦ Communicating with patients and families about the plan of care. ◦ Leading and facilitating Complex Case Review. ◦ Identification and documentation of potentially avoidable days. ◦ 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. Adheres to Utilization Management Plan. Integrates National standards for care management scope of services including: ◦ Utilization Management supporting medical necessity and denial prevention. ◦ Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction. ◦ Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care. ◦ Education provided to physicians, patients, families, and caregivers.
Communicates appropriately and timely with the interdisciplinary team and third-party payers. Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas. Develops collaborative relationships with patient business, nursing, physicians, and patient/family to facilitate efficient movement through the continuum of care.
Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement. Forwards identified quality and/or risk issues appropriately. Maintains positive relationships with outside/onsite reviewers and other payer representatives.
Identifies cultural, socio-economic, religious, and other factors that may impact treatment. Involves patient’s family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family. Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members.
Prioritizes workload to manage multiple priorities while using problem-solving skills to meet goals. Enhances professional growth by participating in educational programs, current literature and/or workshops. Possesses excellent interpersonal skills and ability to work in a team environment.
Respects the rights and privacy of others and holds staff member information in strict confidence. Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards. Maintains compliance with all Orlando Health policies and procedures.
Other Related Functions Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining confidentiality of data and patient information. Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information. Actively serves on committees and task forces to promote quality, cost-effective care for patient population.
include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy. Performs other duties as assigned or required. Qualifications Education/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.
Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.