Manager

divh2Clinical Care Coordinator / h2pResponsible for providing leadership and management of clinical care coordination, utilization management, and discharge planning. Assists the director with patient-centered systems, processes, and outcomes of clinical care teams and programs designed to address clinical, psychosocial, and financial needs of patients and families. Responsible for training, supervision, and evaluation of team members and participation in goal setting, program planning, workflow process monitoring, regulatory compliance, staff productivity, and assessment of good customer service, quality of work, outcome evaluation, and continuous quality improvement. Participates in and / or conducts LEAN and other quality improvement efforts. / ppJob Specific Duties : / pulliEnsures compliance with utilization review, annual plan, JC / DNV-GL, CMS / Federal and State requirements, and professional standards for case management, utilization review / utilization management, discharge planning / care coordination, and transitions of care through policy and procedure development, implementation, and monitoring of standard work. / liliEnsures documentation compliance of the care management department and assists and develops action plans to address variances. / liliCommunicates as a role model for the organizations Service Standards in performance of duties and interaction with patients, families, staff, and all disciplines. / liliAssists Director in designing, implementing, and maintaining efficient systems and processes which promote departmental efficiency, productivity, and assure compliance with regulatory standards. / liliControls work operations by establishing and implementing objectives, practices, and methods and develop corporate care management strategies. / liliSupports the daily operations of the care management department (Inpatient / Outpatient / Emergency Dept) and assesses and regulates staff compliance with the hospitals high standards for exemplary customer service and communication. Promptly investigates problems / complaints and resolves when possible. / liliActs as an administrative liaison with third party insurers as appropriate to facilitate resolution of medical necessity determinations and fiscal denials. Monitors, reports unusual incidents, patterns, and processes within the department and recommends changes and improvements. Advocates and escalates plan of care delays. / liliFosters an exceptional teamwork environment with nursing teams and interdisciplinary colleagues, coaches staff in building strong team dynamics. Promotes professional growth and development of employees. Maintain annual education participation and involvement with qualified Care Management and other education platforms that support acute care, academic, and ambulatory care environment. Contribute to elevate quality of care and improve outcomes with evidence-based healthcare solutions. / liliMeets regularly with Director and staff to share plans and ideas and performance improvement strategies per departmental plan. Meets regularly with staff to ensure employee engagement across the department and that staff receive consistently clear information, direction, and assistance. / liliParticipates in development and implementation of appropriate patient / family education material pertinent to population served. Participates in development of quality indicators and analysis of such indicators per departmental quality performance improvement plan. Identifies and implements strategies to support hospital and departmental missions and priorities contributes or co-leads quality improvement committees and initiatives using evidence-based practice to initiate change and to drive improvement strategies. / liliAssists team members to establish effective collaborative relationships with representatives of third-party payors and external health care agencies in ways that contribute to these providers development of an enhanced image of our hospital and health systems. / liliEstablishes stewardship of financial material and human resources that assist the Director in managing resources to meet budgetary goals while responding effectively to necessary program changes and altered staffing levels. Maintain and / or provide input for schedules and utilizes staff with flexibility so that the workloads are equitably distributed and productivity goals are met. / liliProvides positive communication skills in establishing and fostering professional working relationships and uses consistent positive communication skills when offering assistance or making suggestions. / liliMonitors, controls, and evaluates the quality and quantity of the staff effectiveness and work products. Recruits, orients, coaches, develops, supervises, and evaluates direct reports that contributes to staff retention within the department. Assists all employees enhance and maximize skills necessary for great performance. / li / ulpQualifications : / ppMinimum Job Requirements : / pulliBachelors Degree BSN from an accredited RN program / liliRN - Registered Nurse RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) maintain active and in good standing throughout employment / lili3-5 years Clinical experience / lili4-7 years Case management or utilization management with some discharge planning experience / lili4-7 years Supervisory or management experience in related setting and program function / li / ulpKnowledge, Skills, and Abilities : / pulliMasters of Science in Nursing preferred. / liliCase Management Certification or equivalent in Case Management American Board of Quality Assurance and Utilization Review Physicians Inc. (ABQAURP) or Certified Professional Healthcare Quality (CPHQ) preferred. / liliMembership in case management and / or related specialty professional organization preferred. / liliTransitions of care experience preferred. / liliKnowledge and understanding of laws, rules, regulations, and reimbursement regarding managed care and commercial insurance and federal and state government programs such as Medicaid and Medicare. / liliDemonstrated leadership and organizational abilities. / liliDemonstration of consistency, independence, flexibility, initiative, creativity, resourcefulness, effective written and verbal communications, diplomacy, organizational, and analytic skills. / liliSelf-directed, assertive, and creative in problem solving, systems planning, and patient care management. / liliSkill in analyzing information, data, and problems. / liliAbility to design and / or implement data collection tools. / liliStrong analytical skills. / liliCompetent to expert use of Microsoft Office. / liliDemonstrated proficiency in managing software such as Cerner Millennium, Meditech EHR / EMR, EPIC, Allscripts, and other related software. / li / ulpJob : Nursing - Management Department : CASE MANAGEMENT-2100-866001 Job Status : Full Time / p / div