Care Management - Manager

Orlando Health•Orlando, FL

2d•Onsite

About The Position

Leads the care management team in facilitating appropriate use of hospital resources and effective discharge planning and coordination of services to transition patients to the next appropriate level of care. This position can be filled by a Registered Nurse with Care Management experience or a MSW with such experience. This will be a full time salaried position and is on site at the Dr. Phillips Hospital.

Requirements

Graduate of an approved school of nursing, Master’s in Social Work (MSW), Mental Health Counseling (MHC), or Marriage and Family Therapy (MFT).
Florida RN license required and maintained current if graduated from an approved school of nursing.
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.

Nice To Haves

Preferred to include at least two (2) years in utilization management

Responsibilities

Knowledge of hospital and department policies and procedures as well as knowledge ofregulatory requirementsrelevant to the care management department.
Ability to compile, analyze and interpret data to include the advanced application in spreadsheet generation and the use of graphics, database management and word processing software.
Serves as facilitator to physicians and nursing staff on utilization and discharge planning, care coordination, and utilization management issues.
Demonstratesthe knowledge of labor and expense budgets, as well asrevenue and census projections/ development.
Maintains confidentiality of data and information
Manages educational, financial and human resources for the care management teams to deliver high quality, cost effective, and responsive patient-focused health care services.
Coordinates the workload distribution and scheduling of the care management team members to assure adequate and appropriaten staffing to meet the needs of patients and families within the Orlando Health network.
Develops collaborative relationships with the site leadership, medicalstaff leadership, managed care contractors, and community leaders.
Supports positive relationships with payors and develops plansto optimize reimbursement and quality of care.
Monitors working DRGs and GMLOS assignment as appropriate.
Implementsthe performance improvement processto include outcome measurement asitrelatesto the identification of processes/strategies/ opportunities that promote population health.
Achievesresults by developing strategiesto manage patient care acrossthe continuum, focusing on high risk, high cost and problem prone areas to include patient at risk for re-admission.
Supports processes for clinical quality/ cost-improvement initiatives/ preventing re-hospitalizations.
Develops recommendations to expand the integration of post-acute care services and hospital operations to better meet the needs of Orlando Health and the community.
Designs educational strategies to assure compliance with regulatory standards for NCQA, HIPAA, CMS, and other local, state and federal organizations as applicable.
Coordinates budget implementation with regard to payroll,supplies and miscellaneous otherfunctionsthat deal with the financial performance of the departments overseen,
Serves as a department intermediary forservice problems.
Ensuresincident reports are completed appropriately and follows up with incidentreports as needed.
Organizes/leadsstaff meetings and huddles.
Embraces, promotes and communicates change.
Demonstrates professional accountability by maintaining proficiency in assigned role and involvement in professional organizations and continuing education.
Holdsself and others accountable to Orlando Health’s mission, vision and values.
Develops and recommends concepts relative to new business opportunities, subsidiary organizations, acquisitions, current business design or other organization structuring to optimize organizationalstrength and meet operating mission.
Manages various human resources functions including hiring, work assignments, coaching plans, and performance counseling.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
Maintains compliance with all Orlando Health policies and procedures