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The Case Manager Manager acts as a patient advocate/care coordinator to hospital clients. Provides expertise for enhancing the quality of patient management, satisfaction, continuity of care and timely cost effective practices. The manager coordinates, negotiates, procures services and resources for, and manages the care of complex patients. Applies review criteria to determine medical necessity for admission and continued stay. Additionally, performs care coordination and discharge planning functions Assesses readmissions and assists the quality management process by identifying trends and establishing plans of correction where appropriate. The manager of care coordination collaborates with the interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.

In addition to the above administrative responsibilities, the manager may be responsible to function as a Case Manager as well. This position will assist the director with physician, patient and family issues, multidisciplinary treatment team, Managed Care plans, and when indicated, legal representative(s). Facilitates delivery of clinical and community services to patients and families through effective utilization of available resources. Manage the observation patient process, assist the Admitting department with bed assignment and appropriate placement, conduct InterQual® reviews, EQ Health reviews, coordinate monthly statistics for data reporting-Avoidable data, denial data and Physician Advisor reviews, HINN Data. Ensures the appropriateness and cost effectiveness of treatment as well as generating all the letters to the physicians from the Utilization Management Committee Meeting. Proactively works with physician(s) regarding medical necessity for hospital services. Facilitates decision making in establishing an evaluation program, an interdisciplinary treatment plan, and an assessment of the patient's status and need for provision of continuing care. Work weekends if and when necessary.

CORE QUALIFICATIONS

Education:

Bachelor’s degree in relevant field required

Certification and Licensing:

Valid State of Florida RN license required

Refer to department description for applicable certification requirements

Work Experience:

A Minimum of five years in Hospital Case/Care Management/nursing and 1 year of management, a good working knowledge of patient assessment, medical terminology, the ability to adapt and facilitate change, Computer knowledge, ability to effectively communicate in English, a professional appearance. JCAHO Standards, Quality Improvement Process, and Risk Management knowledge. Infection Control Surveillance and Standard Precautions knowledge of basis regulations in the healthcare setting. Active participant in continuing education and professional groups in order to remain current in practice and changes in regulations as it relates to CMS, State, Federal and Local governing bodies.

ESSENTIAL FUNCTIONS:

1. Technical Duties: Proficient in math applications and use of spreadsheet programs; ability to operate word processing equipment; advanced written communication skills including grammar, spelling, and punctuation; thorough understanding of all regulations regarding personnel practices.

2. Motor Skills: Ability to input data to computer.

3. Interpersonal Skills: Ability to interact with others in a professional, courteous, tactful manner; ability to act as a consultant to case managers, Social Workers and Leadership.

4. Mental Abilities: Organize and prioritize; analyze situations and develop alternatives; analyze data and develop valid conclusions, develop clear, concise policies, procedures and correspondence; provide clear direction to others; manage duties in an environment of changing priorities and frequent deadlines.

5. Sensory Requirements: Ability to communicate with others via telephone; ability to read written documents.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status:

Full time

Employee Type:

Staff