Manager, Care Management

Position Summary Manager of Care Management at Winnie Palmer Hospital for Women & Babies. This role leads the care management team in ensuring effective discharge planning, resource utilization, and coordination of patient services for transitions to appropriate levels of care. Responsibilities Manages educational, financial and human resources for the care management team to deliver high quality, cost‑effective, patient‑focused health care services. Coordinates workload distribution and scheduling of team members to ensure adequate staffing for patient and family needs. Develops collaborative relationships with site leadership, medical staff leaders, managed care contractors, and community leaders. Supports positive relationships with payors and develops plans to optimize reimbursement and quality of care. Monitors DRGs and GMLOS assignment as appropriate. Implements performance improvement processes, including outcome measurement related to population‑health initiatives. Develops strategies to manage patient care across the continuum, focusing on high‑risk and high‑cost areas, including patients at risk for readmission. Supports clinical quality and cost‑improvement initiatives and prevention of rehospitalizations. Recommends expansion of post‑acute care services and hospital operations to meet community needs. Designs educational strategies to assure compliance with regulatory standards (NCQA, HIPAA, CMS, and other local, state and federal organizations). Coordinates budget implementation for payroll, supplies, and other financial performance functions. Serves as a departmental intermediary for service problems. Ensures incident reports are completed appropriately and followed up as needed. Organizes and leads staff meetings and huddles. Embraces, promotes, and communicates change. Demonstrates professional accountability through ongoing education and professional involvement. Holds self and others accountable to Orlando Health’s mission, vision and values. Recommends concepts for new business opportunities, subsidiary organizations, acquisitions, and organization structuring to optimize strength and mission fulfillment. Manages HR functions including hiring, assignments, coaching, and performance counseling. Maintains regular, punctual attendance in accordance with Orlando Health policies and applicable federal, state and local regulations (ADA, FMLA). Maintains compliance with all Orlando Health policies and procedures. Qualifications Education / Training Graduate of an approved school of nursing, Master’s in Social Work (MSW), Mental Health Counseling (MHC), or Marriage and Family Therapy (MFT). Licensure / Certification Florida RN license required and maintained if graduated from an approved nursing program. Experience Three years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Preferably includes at least two years in utilization management. #J-18808-Ljbffr