Job Title: Case Manager RN Job Description We are seeking a dynamic Case Management Registered Nurse to join our team. The RN Case Manager plays a pivotal role in facilitating the interdisciplinary plan of care with a focus on evaluating the appropriateness of medical necessity, admission status, level of care, and discharge planning. The position involves coordinating activities that promote quality outcomes and patient throughput while identifying potential barriers to patient throughput and quality outcomes, and facilitating appropriate discharge plans. Responsibilities * Conduct initial and ongoing assessment of each individual patient regarding clinical condition, level of care, and plan of care. * Review admission and pre-op orders for all components necessary for preadmission and admission processes. * Assist physician offices in obtaining necessary assessments prior to surgery, procedures, and/or admission. * Include patients and families in care facilitation and educational activities. * Assist in the development and implementation of critical pathways. * Utilize computer support and physician advisor to determine potential outliers in continued hospital stay. * Communicate benefits and changes in various benefit plans to physicians, patients, and families as appropriate. * Manage payor denials and issue hospital-initiated notices of non-coverage (HINN's). * Distinguish between levels of care available and coordinate care across the continuum with various benefit plans. * Define desired clinical outcomes, set target dates, and establish a plan for required services and care. * Participate in interdisciplinary team rounds. * Conduct utilization review, evaluate clinical information, and communicate findings to physicians and payors in accordance with utilization review plans and managed care agreements. * Submit clinical information to insurance companies to ensure all days are authorized. * Apply decision support criteria appropriately. * Maintain accurate, up-to-date documentation. * Be cross-trained to function in any assigned Case Manager areas. * Promote close alignment with medical and ancillary staff to facilitate appropriate patient care. Essential Skills * Recent acute care case management experience within the last year or 2-3 years of ICU or strong Med-Surg experience. * Good critical thinking skills and understanding of medical needs for patients. * Florida RN license or approved multistate RN license required. * Basic Life Support (BLS) certification required within 30 days of start. * Three years of RN experience in an acute care setting required. * Graduate of an accredited school of nursing as an RN. Additional Skills & Qualifications * Certification in Case Management, Nursing, or Utilization Review is preferred. * Bachelor of Science in Nursing (BSN) preferred. Work Environment Available shifts are Monday to Friday, day shift from 8:00 AM - 4:30 PM and afternoon shift from 12:00 PM - 8:30 PM, with flexibility to accommodate 11:00 AM - 7:30 PM if needed. The hospital is a 523-bed, full-service medical and surgical acute care center, committed to patient safety and quality of care, and fully accredited by the Joint Commission. Pay and Benefits The pay range for this position is $66560.00 - $98280.00/yr. Benefits HCA Florida Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away from Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Workplace Type This is a fully onsite position in Gainesville,FL. Application Deadline This position is anticipated to close on May 21, 2025. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [email protected] for other accommodation options.