RN Care Manager - Acute Case Management - Days - Bayfront Hospital

About the Role

The RN Care Manager, Acute, is a registered nurse responsible for coordinating patient care across the continuum, ensuring safe, efficient, and appropriate utilization of healthcare resources while maintaining a strong focus on quality outcomes. This role 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.

Responsibilities

• Care Coordination:
  • Assess patients upon admission for discharge planning needs
  • Develop and implement individualized care transition plans
  • Collaborate with physicians, nurses, social workers, therapists, and ancillary services
  • Ensure smooth transitions to post-acute care (SNF, rehab, home health, hospice)
  • Prevent avoidable delays in care or discharge
  • Monitor length of stay (LOS) and address barriers early
  • Participate in payer communication and authorization processes
• Discharge Planning:
  • Identify social, financial, and clinical barriers
  • Coordinate with families and caregivers
  • Arrange services such as DME, home health, transportation, or community resources
  • Ensure safe and timely discharge to the appropriate level of care
• Patient & Family Advocacy:
  • Educate patients and families about care plans and options
  • Promote informed decision-making
  • Address Social Determinants of Health (SDOH) impacting recovery
• Compliance & Documentation:
  • Maintain accurate documentation supporting medical necessity
  • Ensure regulatory and accreditation standards are met
  • Participate in quality improvement initiatives

Qualifications

• Education: Graduate of an approved school of nursing
• Licensure/Certification: Must hold and maintain a current Florida RN license
• Experience: Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care

Essential Functions

• Initially and concurrently assess all patients within assigned population, including:
  • Accurate medical necessity screening and submission for Physician Advisor review
  • Care coordination encompassing admitting diagnosis, medical history, treatments, age, payment source, resources, support systems, anticipated needs, expected LOS, level of service, and special needs
  • Assignment of initial DRG to determine GMLOS, monitoring and managing LOS, and transition planning
  • Leading multi-disciplinary patient care conferences and managing concurrent disputes
  • Making appropriate referrals to other departments and identifying complex patients for Social Work Services
  • Communicating with patients and families about the plan of care
  • Identifying and documenting potentially avoidable days and over/underutilization
• Ensure compliance with regulatory standards, including Federal, State, Local, and Joint Commission requirements
• Integrate national standards for care management scope of services, including Utilization Management, Transition Management, and Care Coordination
• Communicate with the interdisciplinary team and third-party payers, prioritizing activities in high-risk, high-cost areas
• Develop collaborative relationships with stakeholders to facilitate efficient movement through the continuum of care
• Monitor and evaluate data to implement improvement strategies, forwarding quality and risk issues as needed
• Maintain positive relationships with reviewers and payer representatives, considering cultural, socio-economic, and religious factors in treatment
• Involve patients’ families in treatment planning and explain procedures in age/developmental/educational-specific terms
• Prioritize workload, enhance professional growth, and maintain compliance with Orlando Health policies and procedures

About Orlando Health Bayfront Hospital

Orlando Health Bayfront Hospital is a 480-bed teaching medical center in St. Petersburg, FL, serving the community for over 100 years. It offers nationally recognized care in emergency medicine, cardiology, neurosurgery, orthopedics, women’s services, and advanced surgical specialties. As the only adult trauma center in Pinellas County and a Level III Regional Perinatal Intensive Care Center, it is committed to quality, earning a USA Today Top Workplaces award for 2025 and an “A” Hospital Safety Grade from The Leapfrog Group. Part of the Orlando Health system, Bayfront combines regional healthcare resources with personalized, community-focused care.

Why Orlando Health

• Education & Career Growth Assistance
• Comprehensive Health & Wellness coverage and resources
• Financial & Retirement Planning with Company Match
• Excellent Company Culture and Work-Life Balance
• Family & Pet Support and more!

Schedule: 8am-4:30pm Mon-Fri with weekend rotations (up to 1-2 weekends per month) and holiday rotation