Position Summary Site: Orlando Health Bayfront Hospital - St. Petersburg, Florida Department: Case Management Position: Registered Nurse Care Manager
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 hospital has areas of expertise in heart and vascular, digestive health, orthopedics, surgical services, robotic surgery, rehabilitation, neurosciences, maternity care, emergency services, and trauma care. The hospitals 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 Childrens Hospital, is one of Floridas 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 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 Floridas 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.
Job Overview Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patients most likely to benefit from care coordination services, including assessing patients risk factors and the need for care coordination, clinical utilization management, and the transition to the next appropriate level of care.
Responsibilities • Initially and concurrently assesses all patients within assigned population, including 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-on-site reviewers and other payer representatives • Identifies cultural, socio-economic, religious, and other factors that may impact treatment • Involves patients and families in the development of the treatment plan as appropriate, while explaining procedures, therapies, systems, treatment plans, and discharge plans in age-developmentally specific terms to patients/families • Reviews patients 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 Healths 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 • Other Related Functions: • 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 the 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
Qualifications Education/Training: • Graduate of an approved school of nursing
Licensure/Certification: • Maintains current Florida RN license • Maintains current 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