- Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review o Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information. o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines. o Leading and facilitating multi-disciplinary patient care conferences o Managing concurrent disputes o Making appropriate referrals to other departments o Identifying and referring complex patients to Social Work Services o Communicating with patients and families about the plan of care o Leading and facilitating Complex Case Review o Identification and documentation of potentially avoidable days o Identification and reporting over and underutilization
- Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid and Campus related to admission and continued stay approval.
- Adheres to Utilization Management Plan.
- Integrates National standards for care management scope of services including: o Utilization Management supporting medical necessity and denial prevention o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care o Education provided to physicians, patients, families and caregivers Qualifications Education/Training
- Graduate of an approved school of nursing. Licensure/Certification
- Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
- BLS/Healthcare Provider Certification within 90 days of hire. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
- Graduate of an approved school of nursing. Licensure/Certification
- Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
- BLS/Healthcare Provider Certification within 90 days of hire. Experience Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
- Initially and concurrently assesses all patients within assigned population to include, but not limited to: o Accurate medical necessity screening and submission for Physician Advisor review o Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information. o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines. o Leading and facilitating multi-disciplinary patient care conferences o Managing concurrent disputes o Making appropriate referrals to other departments o Identifying and referring complex patients to Social Work Services o Communicating with patients and families about the plan of care o Leading and facilitating Complex Case Review o Identification and documentation of potentially avoidable days o Identification and reporting over and underutilization
- Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid and Campus related to admission and continued stay approval.
- Adheres to Utilization Management Plan.
- Integrates National standards for care management scope of services including: o Utilization Management supporting medical necessity and denial prevention o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care o Education provided to physicians, patients, families and caregivers
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Care Management Technician
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Care Manager - Ocoee, United States - Orlando Health
Description
Position Summary Med Surg/Inpatient Acute Care Rehab Nursing Who are we: Commission on Accreditation of Rehabilitation Facilities (CARF International Accreditation)- more than 25 years Specialty Rehabilitation Registered nurses - currently 68% CRRN certified Patient population - strokes, traumatic brain injury, multiple injuries, new spinal cord injuries, gunshot wounds, amputations, burns, medical complexity, post covid patients Awarded the Certified Registered Nurse Advocacy Award 2021 by the Association for Rehabilitation Nursing Structured and individualized medical and therapy care State of the art therapy equipment for state-of-the-art care What do we do: Impacting lives of patients and families in the most challenging and life changing times of their lives True interdisciplinary care and teamwork with strong nursing and therapy patient centered collaborative care Acute medical care by specialty nurses Three hours of therapy by acute care PT, OT, ST Team consists of Physical medicine and Rehab MD's, RN, NA, PT, OT, ST, Neuropsychology doctors, rec therapy, social workers, case management, admission liaisons, and dieticians come together weekly for team conference for collaborative team care Specialty education for nursing and therapy Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care.
Responsibilities Essential Functions
