Florida Hospital Kissimmee is a 163 bed community-focused hospital, conveniently located near Walt Disney World. The team here is dedicated to bringing mission-focused, faith-based care to residents and visitors of Osceola and Orange Counties. At the heart of our latest expansion is a new, three-story tower featuring 80 expansive, private patient rooms and a host of modern amenities and technologies. Because we believe family support is an essential part of health and healing, we’ve included large, beautifully decorated family waiting areas with the comforts of home. Plus, each patient room includes ample space for visiting loved ones to relax, work and sleep..
2 / 12 hour shifts per week, weekends included; 10am – 10pm
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 RN Care Manager provides guidance regarding admissions, status decisions, and level of care. The ED 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. Education is provided to physicians and other members of the clinical team on issues related to utilization review including appropriateness of admissions and level of care. The ED RN Care Manager complies with Care Management departmental goals, objectives, and policies and procedures, and supports the Florida Hospital mission. The ED RN Care Manager actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Knowledge, Skills, Education, & Experience 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
- Minimum of five years recent acute care experience
- 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. (Preferred)
- Significant knowledge and understanding of availability of community and post-acute resources and related payer requirements. (Preferred)
- Master’s degree in Nursing (Preferred)
- Minimum of two years of experience in the ED (Preferred)
- 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.(Preferred)
Licensure, Certification, or Registration Required:
- Clear/Active Florida State license as a Registered Nurse
- Case Management certification highly desirable – ACM (Accredited Case Manager), CCM (Certified Case Manager), RN-BC (Board Certified in Case Management) (Preferred)
Demonstrates through behavior Florida Hospital’s Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization’s Performance Excellence Program
- Conducts clinical review using specific indicators and criteria in accordance with regulatory and contractual requirements. Uses established medical necessity criteria as described by policy to conduct screening for medically appropriate admissions and level of care determinations. 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 clinical team regarding Care Management involvement with the patient during the patient’s visit.
- Works as a resource to the ED 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 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 to 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 utilization review activities, statistics, clinical assessments and 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.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Case Manager opportunity with Florida Hospital Kissimmee and apply online today.
RN, ED, Case Manager, East Orlando
Location/Region: Kissimmee, FL