Location Address:9441 Health Center Dr, Land O' Lakes, FL 34637
Top Reasons to Work at AdventHealth Wauchula
Immediate Health Insurance Coverage
Great benefits such as: Educational Reimbursement
Career growth and advancement potential
You Will Be Responsible For:
PRINCIPLE DUTIES AND JOB RESPONSIBILITIES:
Demonstrates through Florida Hospital West Florida Division’s core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork as outlined in organization’s Performance Excellence Program.
· Patient satisfaction scores meet organizational goals for HCAHPS.
· Strives to provide excellence in service to hospital staff, patients and families.
· Consistently assumes authority for department activity.
· Acts as JCAHO chapter leader; ensures patient rights activities such as advanced directive are monitored.
· Adheres to regulatory requirements for reporting incidents such as abuse and neglect.
· Initiates ethics consults and family meetings as necessary.
· Demonstrates care for one another and respect for each person’s unique contributions.
· Serves as a clinical role model for staff. Maintains current skills & knowledge base in Case management and Clinical documentation.
· Conducts regular scheduled and as needed staff meetings.
· Prepares and administers performance evaluation for staff.
· Interviews for positions and makes recommendations for hiring and terminating staff.
· Works to have staff retention.
· Ensures new staff receives complete orientation, as well as periodic review of progress toward independence.
· Conducts 30, 60, and 90-day new employee assessment, administers 90-day competency evaluation.
· Appraises and counsels staff to improve performance through meaningful, timely feedback and performance review.
· Consider factors related to patient safety, effectiveness, cost and impact on practice in the delivery of Case Management services.
· Daily oversight of utilization review activities to ensure compliance with Medicare and Medicaid as well as contractual agreements with Managed Care contracts.
· Ensures staff assign working DRG’s to establish geometric mean LOS, collaborate with CDIS staff to update working DRG as needed throughout the patients stay.
· Ensures that weekly outlier meetings and weekly interdisciplinary meeting take place.
· Aware of and educates the staff to remain vigilant in tracking avoidable days, educate how it influences and improves discharge planning practice.
· Initiates the appeal process for any potential denial cases.
· Collaborates with CFO to develop department budget. Monitors reports for variances and creates action plans as needed.
· Operates within designated budget to maintain expenditures within allocated funds, initiates actions to correct or seeks approval to maintain budget variances.
· Utilizes InterQual®ISD & or Milliman criteria to ensure appropriate level of care settings.
· Confers with hospitals medical director as necessary.
· Completes monthly CM scorecard report. Analysis of results, designs action plans with staff to improve scores not meeting benchmark.
· Prepares reports, data, and other analytical materials used in assessing the effectiveness of the department.
Growth & Development:
· Identifies and assists staff to maintain current information on community resources.
· Maintains knowledge of current managed care contracts, federal statutes, regulations and procedures and applies them in performance of review activities.
· Enhances professional knowledge and development through participation in educational programs, seminars, workshops and professional affiliations to keep abreast of latest trends in field of expertise. Demonstrates an ongoing commitment to learn.
· Demonstrates the knowledge and skills required to lead teams in group’s projects and assignments.
· Ensures documentation by case management team is up to date including assessments, reassessments, and insurance communication.
KNOWLEDGE AND SKILLS REQUIRED:
Individuals must possess these knowledge, skills and abilities and be able to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.
· Application of InterQual® and or Milliman® Criteria set.
· Assessment skills and knowledge application for all ages from newborn to geriatric.
· Assessment of appropriate use of hospital services and care coordination.
· Excellent oral and written communication skills.
· Excellent computer skills for data analysis and reporting.
· Ability to function independently and self-direct.
What You Will Need:
EDUCATION AND EXPERIENCE REQUIRED:
· Graduate of an accredited School of Nursing.
· Three years in Case Management and one year experience at a supervisory/manager level.
EDUCATION AND EXPERIENCE PREFERRED:
· BSN or other health related degree or MSN or health related degree.
· Greater than five years’ experience in Case Management with 3 years’ experience at a LTACH hospital.
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
· Current license of RN in Florida or licensure from another state with verification of application of eligibility for Florida licensure by endorsement.
· LICENSURE OR REGISTRATION in: Case Management or Quality certification such as CCM, CPHM, CPUR, ACM, CPHQ
Manager of Case Management is under the general direction of the COO and has the responsibility for planning, implementing, and maintaining the Case Management department. The Manager is responsible for the daily operations, long term planning and budget of the CM department in accordance with the Utilization Management Plan and department policy and procedures. The Manager is responsible for data management and reporting as mandated by Federal, State and Community regulatory agencies including QIO activities and Corporate required reporting. Personnel management and supervision of case management staff. Fosters cooperative working relationship with members of the Case Management team, physicians and patients to provide quality coordination and progression of care activities including: discharge planning & utilization review.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.