Oversee daily operations of the Case Management utilization review/discharge planning processes, including development and/or participation in the daily assignment as well as delegation of resources to assure daily goals are met.
Provide orientation, education and delegates responsibilities to staff based on governmental, regulatory, payor rules and regulations and staff competency.
Provides oversight of daily initial authorization process to ensure authorization is obtained as soon as possible upon admission.
Responsible for oversight of the daily observation management process.
Monitor documentation compliance for required utilization review (UR) and discharge planning (DC) process efforts, through on-going monitoring of required regulatory elements within the UR/DCP process. Aligns review efforts toward goals of corporate and CMS compliance audits.
What Will You Need:
EDUCATION AND EXPERIENCE PREFERRED:
Associate of Arts in Nursing or Diploma in Nursing upon hire
Case Management in an acute care setting, or Case Management in a post-acute setting/preferred
BSN or MSN preferred
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
Licensed Registered Nurse in the State of Florida upon hire
LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:
Case Management Certification (CCM) or
American Case Management Association (ACMA)
The Team Lead Case Manager is a non-management position directly accountable to the Director of Case Management/Care Management for certain tasks required for the daily operations of the Case Management Department in in accordance with the Utilization Management Plan, department policy and procedures, work standards, as well as assignments.
This individual will assist the Director in data management and reporting as mandated by Federal, State and Community regulatory agencies including assisting with Quality Improvement Organizationâ™s (QIO) activities. The Lead Case Manager will be responsible for participating in the department process improvement monitoring and improvement activities related to utilization of hospital services requirements. The Lead will be responsible to assist the patient, family/guardian and all members of the healthcare team in the discharge planning process. Contributes to the monitoring of the quality and appropriateness of patient care delivered. Provides for safe and supportive environment for all patients, families and coworkers. Promotes and provides for optimum patient outcomes through use of Social Service concepts. Demonstrate positive communication and interpersonal skills with patients, families and coworkers.
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.