Manager, Care Management
3 weeks ago
Position Summary:
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.
Essential Functions
- 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 appropriate staffing to meet the needs of patients and families within the Orlando Health network.
- Develops collaborative relationships with the site leadership, medical staff leadership, managed care contractors, and community leaders.
- Supports positive relationships with payors and develops plans to optimize reimbursement and quality of care.
- Monitors working DRGs and GMLOS assignment as appropriate.
- Implements the performance improvement process to include outcome measurement as it relates to the identification of processes/ strategies/ opportunities that promote population health.
- Achieves results by developing strategies to manage patient care across the 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 other functions that deal with the financial performance of the departments overseen,
- Serves as a department intermediary for service problems.
- Ensures incident reports are completed appropriately and follows up with incident reports as needed.
- Organizes/ leads staff 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.
- Holds self and others accountable to Orlando Healths 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 organizational strength 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.
Other Related Functions
- Knowledge of hospital and department policies and procedures as well as knowledge of regulatory requirements relevant 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.
- Demonstrates the knowledge of labor and expense budgets, as well as revenue and census projections/ development.
- Maintains confidentiality of data and information
- Provides matrices and other dashboard statistics to show the effectiveness of the case management/ care coordination team.
Qualifications:
Education/Training
- Graduate of an approved school of nursing, Masters in Social Work (MSW), Mental Health Counseling (MHC), or Marriage and
Family Therapy (MFT).
Licensure/Certification
- Florida RN license required and maintained current if graduated from an approved school of nursing
- BLS/Healthcare Provider Certification
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Preferred to include at least two (2) years in utilization management.
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