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

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. It is a 480-bed teaching medical center with nationally recognized care across emergency medicine, cardiology, neurosurgery, orthopedics, women’s services, and advanced surgical specialties. The hospital’s Level II Trauma Center is the only adult trauma center in Pinellas County 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 from The Leapfrog Group.

About the role

An RN Case Manager (RNCM) 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. The RNCM 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. This includes assessing patients’ risk factors and the need for care coordination, clinical utilization management, and the transition to the next appropriate level of care.

Responsibilities

• 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
• Identify social, financial, and clinical barriers to discharge
• 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
• Educate patients and families about care plans and options
• Promote informed decision-making
• Address Social Determinants of Health (SDOH) impacting recovery
• Maintain accurate documentation supporting medical necessity
• Ensure regulatory and accreditation standards are met
• Participate in quality improvement initiatives
• Conduct accurate medical necessity screening and submission for Physician Advisor review
• Assign initial DRG to determine GMLOS, while concurrently monitoring and managing LOS
• Lead and facilitate multi-disciplinary patient care conferences
• Manage concurrent disputes
• Make appropriate referrals to other departments
• Identify and refer complex patients to Social Work Services
• Communicate with patients and families about the plan of care
• Lead and facilitate Complex Case Review
• Identify and document potentially avoidable days
• Identify and report over and underutilization
• Ensure compliance with all regulatory standards including Federal, State, Local, and Joint Commission
• Adhere to Utilization Management Plan
• Integrate national standards for care management scope of services
• Communicate appropriately and timely with the interdisciplinary team and third-party payers
• Prioritize activities in assigned areas to focus on high risk, high cost, and problem-prone areas
• Develop collaborative relationships with patient business, nursing, physicians, and patient/family
• Monitor and evaluate data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement
• Maintain positive relationships with outside/onsite reviewers and other payer representatives
• Identify cultural, socio-economic, religious, and other factors that may impact treatment
• Involve patient’s family in the development of the treatment plan as appropriate
• Review patient’s discharge plan at multidisciplinary meetings to facilitate communication
• Prioritize workload to manage multiple priorities while using problem-solving skills
• Enhance professional growth by participating in educational programs, current literature, and/or workshops
• Maintain compliance with all Orlando Health policies and procedures
• Perform other duties as assigned or required

Requirements

• Graduate of an approved school of nursing
• Current Florida RN license
• Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care

Skills

• 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
• Computer literacy
• Excellent interpersonal skills and ability to work in a team environment

Schedule

Day shift, full-time: 8:00 AM – 4:30 PM, Monday through Friday with weekend rotations (up to 1-2 weekends per month) and holiday rotation.

Benefits

• 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
• Benefits begin on day one