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Case Management Manager

Req #: 17005784
Location: Tampa, FL
Job Category: Case Management
Organization: Florida Hospital Tampa

Description

Work Hours/Shift

Days

Florida Hospital Tampa

Our hospital has celebrated many firsts in Tampa’s health care history since we opened our doors in 1968. Today, more than four decades later, Florida Hospital Tampa continues to offer innovative medicine as we elevate health care in the Tampa Bay region.

 

At Florida Hospital Tampa, our diverse clinical specialties provide world-class health care to our patients. We offer the most trusted, expert care in key specialties including cardiovascular care, neurosciences, orthopedics, women's health, cancer and surgery. Our skilled surgeons not only utilize minimally invasive and robot-assisted procedures, but they are also leaders in improving these advanced techniques. 


You will be responsible for:

  • 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.
  • 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 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 long stay, (longer than four days), Medicare and complex case rounds take place.
  • Aware of and educates the staff to remain vigilant in tracking avoidable days, educate how it influences and improves discharge planning practice.
  • Ensures concurrent denials addressed timely, keeps denial rate within benchmarks.
  • Ensures staff compliance with EHR physician advisor referrals for second level reviews.
  • 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.
  • Passes Annual Inter-Rater reliability testing for InterQual.
  • Completes monthly Corporate 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.
  • 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.

 
Qualifications
You will be responsible for:
  • 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.
  • 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 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 long stay, (longer than four days), Medicare and complex case rounds take place.
  • Aware of and educates the staff to remain vigilant in tracking avoidable days, educate how it influences and improves discharge planning practice.
  • Ensures concurrent denials addressed timely, keeps denial rate within benchmarks.
  • Ensures staff compliance with EHR physician advisor referrals for second level reviews.
  • 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.
  • Passes Annual Inter-Rater reliability testing for InterQual.
  • Completes monthly Corporate 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.
  • 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.
 
What will you need?
  • 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.
  • Graduate of an accredited School of Nursing.
  • Three years in Case Management and one year experience at a supervisory/manager level.
  • 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
  • BSN or other health related degree or MSN or health related degree. (Preferred)
  • Greater than five years’ experience in Case Management with 3 years’ experience at a supervisory/manager level. (Preferred)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
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