Senior Director, Case Management Utilization Review, Jackson Memorial Hospital, Full time, Days
2 weeks ago
Department: Jackson Memorial Hospital - CCC Case Management Utilization Review
Address: 1611 NW 12 Ave, Miami, FL 33136
Shift details: Full time, DaysÂ
Why Jackson Memorial Hospital:Â Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida. We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success. Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals.
Summary
The Senior Director of Case Management directs the day-to-day operations of the case management area, including case management of inpatient, outpatient, mental health and revenue cycle.
Responsibilities
- Provides leadership in managed care operations for the Jackson Health System.Â
- Directs the Case Management, Utilization Management, Disease Management and Renal Management Programs.Â
- Develops, implements and manages the PSN Disease Management Program.Â
- Develops, implements and manages the Medipass Disease Management Program for Diabetes, CHF, Hypertension, and Asthma. (Pfizer).Â
- Develops, implements, and manages the CAP Disease Management Program.Â
- Develops, implements and manages the SFCCN AIDS DMI Project for Miami-Dade County.Â
- Directs and manages the concurrent review process for PSN patients within the Jackson Health System.Â
- Provides leadership regarding PRO activities, Clinical Compliance Program and Medicare 7th Scope of Work.Â
- Oversees prospective payment systems related activities for both inpatient and outpatient care.Â
- Co-Directs the countywide Medical Management Program during disasters.Â
- Directs and manages the Medical Foster Care Case Management Program.Â
- Role models behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
- Â The leader understands and adheres to JHS compliance standards as they appear in the Code of Conduct, Compliance Policies, and all other JHS Policies and Procedures and supports the commitment of JHS in adhering to federal, state and local laws, rules and regulations governing ethical business practices for health care providers by demonstrating knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family and organization information.Â
- The leader further understands that JHS is committed to its role in preventing health care fraud and abuse and complying with applicable state and federal laws related to health care fraud and abuse.Â
- This commitment is supported and enabled through an anonymous hotline which serves as one of several mechanisms for reporting suspected fraud, waste and/or abuse, as well as other compliance related issues.Â
- The leader to report through any of the reporting mechanisms (e.g., anonymous hotline, supervisor, Compliance Officer) any suspected health care fraud, waste and/or abuse as well as other compliance-related issues.Â
- Performs all other related job duties as assigned.
Experience
Generally requires at least 10 years of related experience. Management experience is required.
Education
Bachelor's degree in related field is required. Master's degree is strongly preferred.
Credentials
Valid Florida RN license is required. Case Management certification is preferred.
Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.
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