Department:CC017410 Care Management
Job Description Summary: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- License/Registration/Certification
- Current RN FL license is required for nurses or a Medical Doctor's degree for Foreign Medical Graduates (FMG)
- Education
- Bachelor's Degree in Nursing preferred or proof of Medical Doctors Degree required for FMG.
- Experience
- Proof of RN licensure, Foreign Medical Graduate (FMG), or at least 2 years as a Care Manager in a hospital is required.
Benefits:We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:
- 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!
Degree Requirements:Certification: 
