Case Manager RN AdventHealth Winter Park
Location Address: 200 N Lakemont Ave, Winter Park, FL 32792
Top Reasons to work at AdventHealth Winter Park
Winter Park Memorial Hospital has continuously served the residents of Winter Park and its surrounding communities for more than 50 years
Chartered in 1951, the hospital has grown from the visionary efforts of a handful of Winter Park residents and community leaders, to a 307-bed acute care facility that is a model of community health and wellness
Over the years the hospital has continually expanded to meet the needs of the community, adding an upscale obstetrics and Level II Neonatal Intensive Care Unit at The Dr. P. Phillips Baby Place, cancer care at the AdventHealth Cancer Institute, Winter Park, and state-of-the-art surgery, recovery and rehabilitation at the AdventHealth Orthopaedic Institute
You Will Be Responsible For:
Coordinates the integration of social services/case management functions into the patient care, discharge planning processes in collaboration with other hospital departments, external service organizations, agencies and healthcare facilities.
Performs initial case management assessment to determine care coordination and discharge planning needs. Conducts admission and concurrent medical record review using specific indicators and criteria in accordance with regulatory and contractual requirements as well as internal policy. Uses established medically necessity criteria as described by policy to conduct screening for appropriate-ness of admission (IP verses observation) and continued stay for intensity of service/severity of illness. Escalates cases as appropriate and per policy to Physician Advisor and Director. Collaborates with Bed Management to ensure appropriate bed placement based on level of care. Assimilates information obtained from information systems, service schedules, registration area, Bed Management, clinics, other facilities, and insurance companies to accurately assess patient clinical needs and treatment.
Acts as patient advocate by negotiating for, and coordinating resources with payers, agencies and vendors during inpatient and transition phases.
Identifies and communicates quality and risk issues to the appropriate staff/departments in a timely manner.
Acts as a resource and provides staff and physician education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
What Will You Need:
EDUCATION AND EXPERIENCE REQUIRED:
Associates Degree in Nursing
Minimum of two years' recent acute care experience
Minimum of an additional two years' experience in healthcare related fields
EDUCATION AND EXPERIENCE PREFERRED:
Master's degree in Nursing
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.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:
LICENSURE, CERTIFICATION, OR REGISTRATION PREFERRED:
Under general supervision of the Director and/or Manager of Case Management, in collaboration with the patient/family, social workers, physicians and interdisciplinary team, the RN Case Manager ensures patient progression through the continuum of care in an efficient and cost-effective manner. The RN case manager is responsible for identifying, initiating and managing optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety and length of stay management. Support and expertise are provided through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. Care coordination, utilization review and management, as well as discharge planning are accountabilities of this role. Education is provided to physicians and other members of the team on the issues related to utilization review including inappropriate admissions and placements. Payer-based requests regarding individual members are fulfilled, where appropriate and pertinent. The Case Manager adheres to departmental and organizational goals, objectives, standards of performance and policies and procedures, continually ensuring quality patient care and regulatory compliance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
Adventist Health System