RN Care Manager, Case Management - Bayfront Hospital, St. Petersburg

Position Summary

Site:
Orlando Health Bayfront Hospital – St. Petersburg, Florida

Department:
Case Management

Position:
Registered Nurse Care Manager

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 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.

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 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.

• Initially and concurrently assesses all patients within assigned population, including:
  • 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 Inter Qual 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 under utilization
  • 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…