Full-Time
Manager Case Management
University of Miami
Research university in Coral Gables, FL
No salary listed
Company Does Not Provide H1B Sponsorship
Miami, FL, USA
In Person
Bachelor's
Category
 Medical, Clinical & Veterinary (1) |
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Required Skills
Infection Control
Medical Terminology
Nursing
Risk Management
Care Coordination
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Requirements
- A bachelor's degree in a relevant field is required.
- A valid State of Florida registered nurse license is required.
- A minimum of five years of hospital case management, care management, or nursing experience is required.
- At least one year of management experience is required.
- Working knowledge of patient assessment and medical terminology is required.
- Knowledge of Joint Commission accreditation standards, quality improvement processes, and risk management is required.
- Knowledge of infection control surveillance, standard precautions, and basic healthcare regulations is required.
- Knowledge of regulations from the Centers for Medicare & Medicaid Services and state, federal, and local governing bodies is required.
- Proficiency with computer applications, spreadsheet programs, word-processing equipment, and data entry is required.
- The ability to communicate effectively in English is required.
- Advanced written communication skills, including grammar, spelling, and punctuation, are required.
- The ability to organize and prioritize work, analyze situations and data, develop alternatives and valid conclusions, and prepare clear policies, procedures, and correspondence is required.
- The ability to provide clear direction and work effectively amid changing priorities and frequent deadlines is required.
- The ability to interact professionally, courteously, and tactfully with others is required.
- The ability to communicate by telephone and read written documents is required.
Responsibilities
- Act as a patient advocate and care coordinator for hospital clients.
- Enhance the quality of patient management, patient satisfaction, continuity of care, and timely cost-effective practices.
- Coordinate, negotiate, and procure services and resources for complex patients and manage their care.
- Apply review criteria to determine medical necessity for admission and continued stay.
- Perform care coordination and discharge planning functions.
- Assess readmissions and support quality management by identifying trends and establishing plans of correction when appropriate.
- Collaborate with interdisciplinary staff inside and outside the organization.
- Participate in quality improvement and evaluation processes related to patient-care management.
- Function as a case manager when assigned in addition to administrative responsibilities.
- Assist the director with physician, patient and family issues, multidisciplinary treatment teams, managed-care plans, and legal representatives when indicated.
- Facilitate delivery of clinical and community services to patients and families through effective use of available resources.
- Manage the observation patient process and assist the Admitting department with bed assignment and appropriate placement.
- Conduct InterQual reviews and EQ Health reviews.
- Coordinate monthly statistics for Avoidable Data, denial data, physician advisor reviews, and HINN data reporting.
- Ensure the appropriateness and cost-effectiveness of treatment.
- Generate letters to physicians from Utilization Management Committee meetings.
- Work proactively with physicians regarding medical necessity for hospital services.
- Facilitate decision-making for evaluation programs, interdisciplinary treatment plans, and assessments of patients' status and continuing-care needs.
- Work weekends when necessary.
- Act as a consultant to case managers, social workers, and leadership.
- Develop clear direction, policies, procedures, and correspondence for assigned functions.
The University of Miami is a private research university focused on education, discovery, and service, with undergraduate, graduate, and professional programs.
Company Size
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Total Funding
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