Strive to provide excellence in service to hospital staff, patients and families.
Consistently utilize five fundamentals of AIDET Acknowledge, Introduce, Duration, Explanation, Thank you.
Committed to working as a team to improve employee satisfaction and engagement scores.
Demonstrate care for one another and respect for each person's unique contributions.
Provides utilization review care that is non-judgmental and non-discriminatory.
Demonstrates respect for human dignity and self-worth.
Respects patient privacy, confidentiality, and dignity by adherence to all HIPAA regulations.
Maintains a professional appearance and manner.
Consider factors related to patient safety, effectiveness, cost and impact on practice in the delivery of Case Management services. Strives to reduce Medicare and ALOS below established benchmarks.
Assess appropriateness of setting as indicated for medical necessity according to the approved InterQual ISD criteria. Initial and concurrent clinical reviews contain needed elements to sufficiently support.
Utilizes InterQual(r)ISD criteria to ensure appropriate level of care settings.
Passes Annual Inter-Rater reliability testing for InterQual(r).
Apply appropriate Inpatient, Observation or Outpatient in a bed admission status.
Screens for lowest level of safe care and initiate referrals and communication with HHC, ALF, DME, SNF, Insurance providers.
Provide information to patients and families for resources in the community for care, financial assistance etc.
Strives to reduce the Medicare & ALOS to below established benchmarks.
Strives to reduce the number of observation cases and the number of hours patients remain in observation status.
Ensures appropriate referral of cases for second level review.
Documents in approved EHR and electronic tools to ensure information for data collection and productivity.
Facilitates staff and physicians to utilize Core Measure order sets and protocols.
Educates physicians and staff on community resources when needed.
Identifies and updates current information on community resources.
Maintains knowledge of current managed care contracts, federal statutes, regulations and procedures and applies them in performance of review activities.
Enhances professional knowledge and development through participation in educational programs and in-service meetings. Stays current with journal articles etc.
Completes annual mandatory education.
Honor's patient's rights by following privacy guidelines and code of ethics
Demonstrates honesty and fairness in all actions and behaviors and accepts accountability for ones actions.
Recognize and anticipate the needs of others and go beyond their job to exceed expectations of those we serve.
Greets everyone they encounter with a smile, using caring tone during conversations, and makes frequent and appropriate eye contact.
Use common courtesy practices such as helping lost individuals, saying please and thank you, and knocking on a patient's door before entering.
Proactively support a culture of safety and quality.
Listen respectfully and avoid defensiveness in verbal and non-verbal communication. Exhibit willingness to assist co-workers.
Display support in organizational decisions in their communication and actions.
Refrains from gossiping and spreading rumors.
Looks for opportunities to support, recognize and celebrate teamwork.
What You Will Need:
Graduate of an accredited School of Nursing, Specific Degree/Major: Nursing
Current license of registered nurse in Florida or licensure from another state with verification of application of eligibility for Florida licensure by endorsement
Application of InterQual(r) Criteria set.
Assessment competency and knowledge application for all ages from newborn to geriatric.
Assessment competency for appropriate use of hospital services and care coordination.
EDUCATION AND EXPERIENCE PREFERRED:
Greater than three years' experience in healthcare
Case Management Certification
Any combination of education, training or experience that provides the knowledge, skills and abilities required to successfully accomplish the assigned duties and responsibilities of the position.
One year acute-care nursing, charge nurse, emergency department, or crucial care nursing experienced.
The Case Manager is accountable for the organization, to facilitate the flow of patients to the next site (level) of care including inpatient acute care, community services or transfer to another facility/campus, sequence of services and resources that are necessary and appropriate for the achievement of patient care outcomes within effective time frames on a specific group of patients. In addition, the Case Manager will coordinate the plan of care among all members of the health care team. The Case Manager must have the professional ability to practice under minimal supervision and perform the following seven essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation, with emphasis on decreasing length of stay and monitoring cost effective health care across the continuum of care. The Case Manager must continually review the patient to facilitate status, patient needs with the appropriate level and type of medical, psychosocial, or social service as they relate across the continuum of care. The Case Manager evaluates patients for appropriateness, medical necessity, benefit systems and cost benefit analysis within the caseload according to Case Management Department Plan, policies and procedures.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.