Committed to working as a team to improve Employee satisfaction and engagement scores.
Demonstrate care for one another and respect for each personâ™s unique contributions, provides utilization review care that is non-judgmental and non-discriminatory.
Demonstrate 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 InterQualÂ®ISD & or Milliman criteria to ensure appropriate level of care settings.
Passes Annual Inter-Rater reliability testing for InterQualÂ®.
Inpatient, Observation or Outpatient in a bed admission status.
Introduce self to patient/family within 24 to 48 hours of identification of high risk criteria or referral for specified populations and explain CM role. Complete discharge planning screening tool within 24 to 48 hours for patients with high risk criteria, and cases received by referral. Provide Parent/Patient/ Guardian/ Significant Other with discharge planning education/instruction based on assessed education level, barriers to learning and learning preferences to assure a positive discharge outcome.
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 to EHR for second level review.
Identifies and updates current information on community resources.
Maintains knowledge of current managed care contracts, federal statutes, regulations and procedures.
Applies them in performance of review activities.
Enhances professional knowledge & development through participation in educational programs and in-service meetings. Stays current with journal articles etc.
Completes annual mandatory education, attend and contributes to 95% of staff meetings.
What You Will Need:
Individuals must possess these knowledge, skills and abilities and be able to explain and to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.
Application of InterQualÂ® 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.
Ability to work independently.
Graduate of an accredited School of Nursing, Specific Degree/Major: Nursing.
One year experience in Case Management in an acute care environment.
Current license of registered nurse in Florida or licensure from another state with verification of application of eligibility for Florida licensure by endorsement.
The Case Manager is accountable for the organization, 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 complete all initial admission assessments within 24 hours of inpatient admission and match the patientâ™s ongoing needs with the appropriate level and type of medical, health, psychosocial, or social service as they relate across the continuum of care.
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.