All the benefits and perks you need for you and your family:** + Benefits from Day One + Paid Days Off from Day One + Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense)* **For Eligible Positions** **Our promise to you:** Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Schedule:** Full Time **Shift** : Days **Location:** 701 EAST ALTAMONTE DRIVE, Altamonte Springs, 32701 **The role you’ll contribute:** Under minimal supervision, the Director – Care Management - System develops and coordinates implementation of complex hospital strategies, involving physicians and multiple hospital departments, to assure appropriate utilization of hospital resources, appropriate level of care for patients, and appropriate discharge planning. Responsible for assuring appropriateness of patient admissions based on severity of illness/intensity of service criteria. Facilitates case reviews based on medical screening criteria and oversees denial management process to third party payers to ensure optimum reimbursement. Responsible for case management, utilization review and social worker/discharge planning processes for AdventHealth business units. Responsible for building and maintaining positive working relationships with medical staff, external agencies (ECF’s, sub-acute facilities, Home Care) and all members of the health care team. Responsible for on-going operations, short- term and long-term planning and development of the outcomes management service area for AdventHealth. Develops and implements state-of-the-art performance improvement and outcomes management programs that enhance the operational, financial, and clinical performance of the organization. Implements and oversees the maintenance and use of databases and systems for measuring, monitoring, and tracking utilization and performance changes. Leads and directs cross-functional teams for achieve results. Works closely with physicians and the campus leadership team on utilization/case management issues. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. **The value you’ll bring to the team:** + Serves as a change agent to re-structure or improve hospital clinical or operational monitoring activities to reflect the philosophy of the evidence based medicine/disease management/clinical programs initiatives. + Assumes implementation responsibilities for change activities required to re-engineer hospital clinical processes to address resource consumption issues. + Educates Medical Staff and hospital administrative staff concerning current trends in cost/resource management. + Identifies clinical topics for review and analysis by medical staff monitoring committees, based on consistent monitoring of clinical practice patterns, feedback from clinicians and physicians and retrospective data analyses of quality, resource consumption and cost reports at a DRG and physician-specific level. + Develops an active, collaborative, interface and structure with AdventHealth Medical Staff Qualifications **The expertise and experiences you’ll need to succeed:** **EDUCATION REQUIRED** **:** + Bachelor’s degree in Nursing **EDUCATION Preferred:** + Master’s degree in Nursing, Business, or health-related field **EXPERIENCE REQUIRED** **:** + Seven to ten years’ acute care hospital clinical experience + Five years’ progressively responsible leadership experience + Previous case management, utilization management, or related discipline experience **LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED** **:** + Current, valid State of Florida license as a registered professional nurse **LICENSURE, CERTIFICATION, OR REGISTRAITON Preferred:** + Nursing specialty certification + Case management certification: Accredited Case Manager (ACM), Certified Case Manager (CCM), Board Certified in Case Management (RN-BS) This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Orlando **Schedule:** Full-time **Shift:** 1 - Day **Req ID:** 25023142 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.