Care Manager

Position ResponsibilitiesProactively identifies patients/individuals in need of care management services/interventionGathers information about assigned populations and prioritizes workload appropriately to meet desired outcomesResponds to referral requests in a timely manner and offers possible alternatives for assistance if referral is not appropriate for care management interventionConducts/documents admissions assessments in a complete and timely manner in accordance with department standardsConducts/documents utilization reviews in a complete and timely mannerUtilizes InterQual criteria and communicates outcomes as indicated/warranted to appropriate partiesMaintains a holistic view of the patient and his/her needsDevelops and documents a plan to address identified barriers to care collaboratively with the patient/family, physician, and interdisciplinary teamDocuments the discharge plan in a complete and timely mannerUpdates the discharge plan as warranted/patient condition changesAppropriately addresses any identified issues that may put a patient at risk for readmissionDiscusses transitions of care and discharge planning with patients and families (HCAHPS)Documents discharge disposition and agencies/facilites related to post-acute care as required by department standardsCompletes and provides all required forms, including but not limited to: the Important Message from Medicare (IM), the Choice Letter, Hospital-to-Hospital transfer forms, SNF transfer forms, the PASRRDemonstrates problem solving skills, critical thinking skills, effective communication, and an appropriate sense of urgency in providing service to avoid delays in progression of careReviews cases for over, under, or inappropriate utilization of resources (including but not limited to unnecessary ED/IP visits, greater than expected LOS, unplanned readmissions, unnecessary testing/treatment, etc.)Develops, maintains, and utilizes skills and a network of resources both internal and external to the organization necessary to problem solve immediate needs of the customer; refers to care management leadership in timely manner if additional support is needed to help resolve/remove barriersParticipates effectively in multidisciplinary roundingSupports patient transitions across the continuum through effective communication and interventions; demonstrates competency in coordinating key services for safe and effective transitions of careDemonstrates appropriate referral to/collaboration with other members of interdisciplinary team or outside agencies as warranted; if patient transferred, communicates patient information to next care manager or outside agency in a timely mannerRefers to colleagues, such as social workers and care management specialists, and escalates cases to management appropriatelyDevelops and maintains knowledge of Medicare, Medicaid, and key payer benefits/reimbursement methodologies necessary to procure services for patients and serve as a resource to the interdisciplinary team on quality and cost-effective careMaintains understanding of, and articulates the regulatory requirements (CMS, TJC, etc.) regarding discharge planning/utilization review and/or care management servicesMaintains a patient centered approach through ongoing communication with patient/family seeking their input and participation at all timesCommunicates in a polite and professional manner to all patients, families, physicians, and colleagues at all timesParticipates in weekend rotation and on-call as requiredDemonstrates sufficient computer skills to perform job function; checks voicemail and email as instructed by leadership and as warrantedQualificationsLicense/Registration/CertificationCurrent RN FL license is required for nurses or a Medical Doctor's degree for Foreign Medical Graduates (FMG)EducationBachelor's Degree in Nursing preferred or proof of Medical Doctors Degree required for FMG.ExperienceProof of RN licensure, Foreign Medical Graduate (FMG), or at least 2 years as a Care Manager in a hospital is required.BenefitsWe believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:Health benefitsLife insuranceLong-term disability coverageHealthcare spending accountsRetirement planPaid time offPet InsuranceTuition reimbursementEmployee assistance programWellness programOn-site housing for select positions and more!Degree RequirementsCertification: