Registered Nurse Care Manager, Case Management - Part-time

Requisition ID
2025-247712
Category
Clinical, Allied & Patient Care
Status
Part-Time
Shift
First
Location
Bayfront Health St Petersburg
Department
BHSP Case Management

Position Summary

Site: Orlando Health Bayfront Hospital – St. Petersburg, Florida
Position: Registered Nurse Care Manager
Schedule: Part-time

 

About Orlando Health Bayfront Hospital
Orlando Health Bayfront Hospital is a comprehensive tertiary care facility that has been serving St. Petersburg and the
surrounding communities for more than 100 years. A teaching medical center, the 480-bed hospital’s areas of
expertise include heart and vascular, digestive health, orthopedics, surgical services, robotic surgery, rehabilitation,
neurosciences, maternity care, emergency services and trauma care. The hospital’s Level II Trauma Center is the only
adult trauma center in Pinellas County. Home to the Center for Women and Babies, the hospital offers full obstetrical
services, and, in partnership with Johns Hopkins All Children’s Hospital, is one of Florida’s 13 state-certified Level III
Regional Perinatal Intensive Care Centers. A commitment to quality has earned the hospital recognition with a USA
Today Top Workplaces award for 2025 and an “A” Hospital Safety Grade for Spring 2025 from The Leapfrog Group.


Orlando Health Bayfront Hospital is part of the Orlando Health system of care, which includes award-winning hospitals
and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida’s
east to west coasts, Central Alabama and Puerto Rico. Collectively, our dedicated team members honor our over
100-year legacy by providing professional and compassionate care to the patients, families and communities we
serve.

Why Join Orlando Health Bayfront Hospital?

  • 2025 USA Today Top Workplace – Join a nationally recognized team that prioritizes employee satisfaction and growth.
  • Spring 2025 Leapfrog Grade “A” for Hospital Safety – Your work contributes to a culture of excellence and accountability.
  • Member of the Orlando Health System – Enjoy long-term career growth and a supportive network across Central Florida.
  • Day-One Benefits – Including FREE education programs, wellness resources, and mental health support.
  • Dream Location – Work just steps away from the white-sand beaches and thriving downtown of St. Petersburg.

Job Summary

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.

Qualifications

Education/Training

  • Graduate of an approved school of nursing.

Licensure/Certification

  • Maintains current Florida RN license and BLS/Healthcare Provider certification are required.

Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.

Responsibilities

Essential Functions

  • Initially and concurrently assesses all patients within assigned population to include, but not limited to:
    • Accurate medical necessity screening and submission for Physician Advisor review
    • 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.
    • 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.
    • Leading and facilitating multi-disciplinary patient care conferences
    • Managing concurrent disputes
    • Making appropriate referrals to other departments
    • Identifying and referring complex patients to Social Work Services
    • Communicating with patients and families about the plan of care
    • Leading and facilitating Complex Case Review
    • Identification and documentation of potentially avoidable days
    • 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:
    • Utilization Management supporting medical necessity and denial prevention
    • Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
    • Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care
    • Education provided to physicians, patients, families, and caregivers.
  • Communicates appropriately and timely with the interdisciplinary team and third-party payers.
  • Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas.
  • Develops, collaborative relationships with patient business, nursing, physicians, and patient/family to facilitate efficient movement through the continuum of care.
  • Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement.
  • Forwards identified quality and/or risk issues appropriately.
  • Maintains positive relationships with outside/onsite reviewers and other payer representatives.
  • Identifies cultural, socio-economic, religious, and other factors that may impact treatment.
  • Involves patient’s family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family.
  • Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members.
  • Prioritizes workload to manage multiple priorities while using problem-solving skills to meet goals.
  • Enhances professional growth by participating in educational programs, current literature and/or workshops.
  • Possesses excellent interpersonal skills and ability to work in a team environment.
  • Respects the rights and privacy of others and holds staff member information in strict confidence.
  • Maintains regular attendance and complies with time and attendance policy and procedures.
  • Adheres to Orlando Health’s policies and procedures, Mission, Vision and Values statement and Code of Conduct.
  • Enhances professional growth by participating in educational programs, current literature and/or workshops.
  • Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining confidentiality of data and patient information.
  • Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information.
  • Actively serves on committees and task forces to promote quality, cost-effective care for patient population.
  • Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and
    computer literacy.
  • Performs other duties as assigned or required

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