Case Manager Jobs

About The Position

Requirements

• Graduate of an approved school of nursing.
• Maintains current Florida RN license and BLS/Healthcare Provider certification are required.
• BLS/Healthcare Provider Certification within 90 days of hire.
• Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
• 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
• Computer literacy

Responsibilities

• 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 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.
• Develops, collaborative relationships with patient business, nursing, physicians, and patient/family to facilitate efficient movement through the continuum of care.
• Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement.
• Forwards identified quality and/or risk issues appropriately.
• Maintains positive relationships with outside/onsite reviewers and other payer representatives.
• Identifies cultural, socio-economic, religious, and other factors that may impact treatment.
• 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.
• Performs other duties as assigned or required

Benefits

• Career-growing FREE education programs
• Well-being services
• Benefits begin on day one
• Flexibility wherever possible