U

University of Miami

Research university in Coral Gables, FL

Manager Case Management

Full-Time
No salary listed
Senior, Expert
Bachelor's
Miami, FL, USA
In Person
Medical, Clinical & Veterinary
Company Does Not Provide H1B Sponsorship

About the job

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.

About the company

U

University of Miami

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The University of Miami is a private research university focused on education, discovery, and service, with undergraduate, graduate, and professional programs.

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