The Manager, Care Management is responsible for leading the case management and care coordination team in facilitating the appropriate use of hospital resources and effective discharge planning and coordination of services to transition patients to the next appropriate level of care.
- Manages educational, financial and human resources for the case management and care coordination teams to deliver high quality, cost-effective, and responsive patient-focused health care services.
- Coordinates the workload distribution and scheduling of the case management/ care coordination team members to assure adequate and appropriate staffing to meet the needs of patients and families within the hospital network.
- Develops collaborative relationships with the site patient care administrators, 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 home health and hospital operations to better meet the needs of the hospital 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 and 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 hospitals 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 the operating mission.
- Manages various human resources functions including hiring, work assignments, coaching plans, and performance counseling.
- Maintains reasonably regular, punctual attendance consistent with hospital policies, the ADA, FMLA, and other federal, state and local standards.
- Maintains compliance with all hospital policies and procedures.
Other Related Functions
- Knowledge of hospital and department policies and procedures as well as knowledge of regulatory requirements relevant to the case management and care coordination 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 a 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.
- Bachelor's degree in health related field or Master's in Social Work (MSW), Mental Health Counseling (MHC), or Marriage and Family Therapy (MFT).Licensure/Certification
- If a Bachelor's degree in Nursing or health-related field must possess and maintain an RN license in the State of Florida.
- Five (5) years of related healthcare experience to include two (2) years of experience in Utilization Management, Discharge Planning, Case Management or Care Coordination.