Care Manager, RN – ED/Observation - AdventHealth Kissimmee

Location Address: 2450 Orange Blossom Trail

Top Reasons to work at AdventHealth Kissimmee

• AdventHealth Kissimmee is an 83-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
• AdventHealth Kissimmee has recently expanded to include a new medical office building, patient tower, and new main entrance

Virtual Tour: https://visit360five.com/start.php?id=14216310

Work Hours/Shift:

• Full Time Days

You Will Be Responsible For:

• 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.

What You Will Need:

• Three years recent acute care experience
• Associate Degree in Nursing
• Current valid State of Florida or multistate license as a Registered Nurse
• Superior clinical skills to determineappropriate clinical and other information for medical necessity reviews andidentify appropriate mechanism to address delays or variation for expected carepractices (Preferred)
• Bachelors degree in Nursing (Preferred)
• Minimum of two years of experience inthe ED (Preferred)
• Minimum of two years of utilizationreview/case management experience and a minimum of one year of experience indischarge planning in an acute care setting (Preferred)
• Case Management certification ACM (AccreditedCase Manager), CCM (Certified Case Manager), RN-BC (Board Certified in CaseManagement) (Preferred)

Job Summary:

Under general supervision ofthe Director and/or Manager of Care Management, in collaboration with thepatient/family, social workers, physicians and interdisciplinary team, theED/Observation RN Care Manager provides guidance regarding admissions. TheED/Observation RN Care Manager, in a team approach with the ED Social Worker/EDstaff, assists with identification of readmissions, patients with potentialneeds for community resources or potential post-acute needs. The ED/Observation RN Care Manager complieswith Care Management departmental goals, objectives, and policies andprocedures, and supports the AdventHealth mission. The ED/Observation RN Care Manager activelyparticipates in outstanding customer service and accepts responsibility inmaintaining relationships that are equally respectful to all.