Manager, Case Management

About the role

The Case Manager Manager acts as a patient advocate/care coordinator to hospital clients. They provide 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. They apply review criteria to determine medical necessity for admission and continued stay. Additionally, they perform care coordination and discharge planning functions.

Responsibilities

• 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.
• 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.
• Avoids inappropriate and cost ineffective treatments and 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.

Requirements

• Education: Bachelor’s degree in relevant field required.
• Certification and Licensing: Valid State of Florida RN license required.

Qualifications

• Work Experience: A Minimum of five years in Hospital Case/Care Management/nursing and 1 year of management, a good working knowledge of patient assessment, medical terminology, the ability to adapt and facilitate change, Computer knowledge, ability to effectively communicate in English, a professional appearance.
• JCAHO Standards, Quality Improvement Process, and Risk Management knowledge.
• Infection Control Surveillance and Standard Precautions knowledge of basis 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.

Skills

• 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.

Benefits

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

Pay

Competitive salary offered.

Schedule

Full-time position.