Position Summary
ORLANDO HEALTH – HEALTH CENTRAL HOSPITAL
Located in Ocoee, Florida, Orlando Health – Health Central Hospital is a 252‑bed comprehensive medical and surgical acute‑care facility that has been serving the residents of west Orange County for more than 70 years. Services range from 24/7 emergency care to cardiovascular and stroke care, neurosciences, oncology, orthopedics, minimally invasive robotic surgery and more. The hospital has accreditations and designations in many specialty services, including bariatric surgery, spine surgery, stroke, and hip and knee joint replacement. We also earned 2024‑25 High Performing Hospital ratings in five areas – COPD, diabetes, heart attack, heart failure and hip replacement – from U.S. News & World Report, and 2024 Top Teaching Hospital recognition from The Leapfrog Group.
Benefits
Orlando Health is committed to providing you with benefits that go beyond the expected, with career‑growing FREE education programs and well‑being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it’s our promise to you.
Responsibilities
Initially and concurrently assess 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 admission 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 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.
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 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
Must hold and maintain a current Florida RN license.
Handle with Care (HWC) Certification is required for the Behavioral Health Unit within 90 days of hire. Handle with Care training and education will be provided onsite to all team members.
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.