Care Manager -PD

Position Responsibilities

• Proactively identifies patients/individuals in need of care management services/intervention
• Gathers information about assigned populations and prioritizes workload appropriately to meet desired outcomes
• Responds to referral requests in a timely manner and offers possible alternatives for assistance if referral is not appropriate for care management intervention
• Conducts/documents admissions assessments in a complete and timely manner in accordance with department standards
• Conducts/documents utilization reviews in a complete and timely manner
• Utilizes InterQual criteria and communicates outcomes as indicated/warranted to appropriate parties
• Maintains a holistic view of the patient and his/her needs
• Develops and documents a plan to address identified barriers to care collaboratively with the patient/family, physician, and interdisciplinary team
• Documents the discharge plan in a complete and timely manner
• Updates the discharge plan as warranted/patient condition changes
• Appropriately addresses any identified issues that may put a patient at risk for readmission
• Discusses 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 standards
• Completes 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 PASRR
• Demonstrates problem solving skills, critical thinking skills, effective communication, and an appropriate sense of urgency in providing service to avoid delays in progression of care
• Reviews 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 barriers
• Participates effectively in multidisciplinary rounding
• Supports patient transitions across the continuum through effective communication and interventions; demonstrates competency in coordinating key services for safe and effective transitions of care
• Demonstrates 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 manner
• Refers to colleagues, such as social workers and care management specialists, and escalates cases to management appropriately
• Develops 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 care
• Maintains understanding of, and articulates the regulatory requirements (CMS, TJC, etc.) regarding discharge planning/utilization review and/or care management services
• Maintains a patient centered approach through ongoing communication with patient/family seeking their input and participation at all times
• Communicates in a polite and professional manner to all patients, families, physicians, and colleagues at all times
• Participates in weekend rotation and on-call as required
• Demonstrates sufficient computer skills to perform job function; checks voicemail and email as instructed by leadership and as warranted

Qualifications

• Current RN FL license is required for nurses or a Medical Doctor's degree for Foreign Medical Graduates (FMG)
• Bachelor's Degree in Nursing preferred or proof of Medical Doctors Degree required for FMG
• Proof of RN licensure, Foreign Medical Graduate (FMG), or at least 2 years as a Care Manager in a hospital is required

Benefits

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!