Registered Nurse - Care Manager at Lake Mary Hospital

Position Summary

Department : LMH Care Management

Status : Full-time (40 hours a week)

Schedule : First Shift

Title : Registered Nurse, Care Management

Orlando Health Lake Mary Hospital

The NEW Orlando Health Lake Mary Hospital represents Orlando Health's continued commitment to the Seminole County community, which we have proudly served for 40 years. As a comprehensive acute care facility, the hospital offers a full scope of medical and surgical services, including cardiovascular, general surgery, orthopedics, and women's services with labor and delivery, alongside a future NICU. Opening with 124 beds, the 455,000 square foot hospital will be able to expand to up to 240 beds. State-of-the-art facilities include operating rooms, catheterization labs, interventional radiology, a vascular lab, an ICU and a full-service emergency department.

For labor and delivery, the hospital features six private suites thoughtfully designed to make you feel at home while providing exceptional medical care. Each suite includes a hydrotherapy tub for laboring, shower, recliner, adjustable bed with a squat bar, wireless and waterproof heart rate monitors for mom and baby, a smart board that integrates patient and nurse information from Epic, WiFi, and televisions. These modern amenities ensure a comfortable and supportive environment for every patient.

• Labor and delivery services, and a future neonatal intensive care unit
• 6 state-of-the-art operating rooms
• 3 catheterization labs with a dedicated interventional radiology and vascular lab
• Comprehensive cardiovascular care
• 16 ICU Beds
• Observation unit
• Outpatient Scripts Pharmacy

Top Reasons to Choose Orlando Health - Lake Mary Hospital :

Position Summary :

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

Essential Functions

o Accurate medical necessity screening and submission for Physician Advisor review

o 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.

o 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.

o Leading and facilitating multi-disciplinary patient care conferences

o Managing concurrent disputes

o Making appropriate referrals to other departments

o Identifying and referring complex patients to Social Work Services

o Communicating with patients and families about the plan of care

o Leading and facilitating Complex Case Review

o Identification and documentation of potentially avoidable days

o Identification and reporting over and underutilization

o Utilization Management supporting medical necessity and denial prevention

o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction

o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level

of care

o Education provided to physicians, patients, families, and caregivers.

Qualifications

Education / Training

Licensure / Certification

Experience

Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.