Manager, Case Management

University of Miami•Miami, FL

16h•Onsite

About The Position

The Case Manager Manager acts as a patient advocate/care coordinator to hospital clients. Provides expertise for enhancing the quality of patient management, satisfaction, continuity of care and timely cost effective practices. The manager coordinates, negotiates, procures services and resources for, and manages the care of complex patients. Applies review criteria to determine medical necessity for admission and continued stay. Additionally, performs care coordination and discharge planning functions Assesses readmissions and assists the quality management process by identifying trends and establishing plans of correction where appropriate. The manager of care coordination collaborates with the interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care. In addition to the above administrative responsibilities, the manager may be responsible to function as a Case Manager as well. This position will assist the director with physician, patient and family issues, multidisciplinary treatment team, Managed Care plans, and when indicated, legal representative(s). Facilitates delivery of clinical and community services to patients and families through effective utilization of available resources. Manage the observation patient process, assist the Admitting department with bed assignment and appropriate placement, conduct InterQual® reviews, EQ Health reviews, coordinate monthly statistics for data reporting-Avoidable data, denial data and Physician Advisor reviews, HINN Data. Ensures the appropriateness and cost effectiveness of treatment as well as generating all the letters to the physicians from the Utilization Management Committee Meeting. Proactively works with physician(s) regarding medical necessity for hospital services. Facilitates decision making in establishing an evaluation program, an interdisciplinary treatment plan, and an assessment of the patient's status and need for provision of continuing care. Work weekends if and when necessary.

Requirements

Bachelor’s degree in relevant field required
Valid State of Florida RN license required
A Minimum of five years in Hospital Case/Care Management/nursing
1 year of management experience
Good working knowledge of patient assessment
Good working knowledge of medical terminology
Ability to adapt and facilitate change
Computer knowledge
Ability to effectively communicate in English
Professional appearance
Knowledge of JCAHO Standards
Knowledge of Quality Improvement Process
Knowledge of Risk Management
Knowledge of Infection Control Surveillance and Standard Precautions
Knowledge of basic regulations in the healthcare setting
Active participant in continuing education and professional groups in order to remain current in practice and changes in regulations as it relates to CMS, State, Federal and Local governing bodies.
Proficient in math applications and use of spreadsheet programs
Ability to operate word processing equipment
Advanced written communication skills including grammar, spelling, and punctuation
Thorough understanding of all regulations regarding personnel practices.
Ability to input data to computer.
Ability to interact with others in a professional, courteous, tactful manner
Ability to act as a consultant to case managers, Social Workers and Leadership.
Organize and prioritize
Analyze situations and develop alternatives
Analyze data and develop valid conclusions
Develop clear, concise policies, procedures and correspondence
Provide clear direction to others
Manage duties in an environment of changing priorities and frequent deadlines.
Ability to communicate with others via telephone
Ability to read written documents.

Nice To Haves

Refer to department description for applicable certification requirements

Responsibilities

Acts as a patient advocate/care coordinator to hospital clients.
Provides expertise for enhancing the quality of patient management, satisfaction, continuity of care and timely cost effective practices.
Coordinates, negotiates, procures services and resources for, and manages the care of complex patients.
Applies review criteria to determine medical necessity for admission and continued stay.
Performs care coordination and discharge planning functions.
Assesses readmissions and assists the quality management process by identifying trends and establishing plans of correction where appropriate.
Collaborates with the interdisciplinary staff internal and external to the organization.
Participates in quality improvement and evaluation processes related to the management of patient care.
May be responsible to function as a Case Manager as well.
Assists the director with physician, patient and family issues, multidisciplinary treatment team, Managed Care plans, and when indicated, legal representative(s).
Facilitates delivery of clinical and community services to patients and families through effective utilization of available resources.
Manages the observation patient process.
Assists the Admitting department with bed assignment and appropriate placement.
Conducts InterQual® reviews, EQ Health reviews.
Coordinates monthly statistics for data reporting-Avoidable data, denial data and Physician Advisor reviews, HINN Data.
Ensures the appropriateness and cost effectiveness of treatment.
Generates all the letters to the physicians from the Utilization Management Committee Meeting.
Proactively works with physician(s) regarding medical necessity for hospital services.
Facilitates decision making in establishing an evaluation program, an interdisciplinary treatment plan, and an assessment of the patient's status and need for provision of continuing care.
Work weekends if and when necessary.