Director of Case Management - Full Time - Days at AdventHealth in Palm Coast, Florida

Job Description:

Description

Director of Case Management AdventHealth Palm Coast

Top Reasons To Work At AdventHealth Palm Coast

• Immediate Health Insurance Coverage
• Great benefits such as: Educational Reimbursement
• Career growth and advancement potential
• High quality of life with low cost of living on the shores of sunny Palm Coast, FL

Work Hours/Shift:

Full Time Days

 

You Will Be Responsible For:

• Develops and oversees programs that monitor resource utilization.
• Creates and oversees implementation of organizational strategies to accomplish utilization and length of stay goals, including organizing and facilitating interdepartmental teams, while ensuring compliance with all Medicare, TJC and licensure requirements.
• Ensures technical and managerial competence of departmental leadership team and compliance with organizational values (ICARE) by the leadership team.
• Develops and monitors department financial planning and budget process.
• Manages department expenditures within budgeted limits as adjusted for facility volumes.
• Ensures resources are appropriately matched to daily workload and monitors and addresses labor and productivity variances.
• Participates in the hiring process.  Completes performance evaluations timely and is involved in employee counseling, coaching and termination per policy.  Provides orientation for new employees and ensures compliance with department policy and procedure. Maintains high levels of employee engagement and job performance by providing recognition and opportunities for learning.
• Ensures performance competency via orientation and coaching.  Assesses employees need for further education. Assures adequate competency of employees for the assigned caseload. 
• Reviews daily correspondence, acts appropriately on requests and information received.
• Evaluates the department/organization’s compliance with TJC, CMS and other regulatory standards and develops, communicates, and enforces departmental policies and procedures consistent with organizational, governmental and TJC standards.
• Develops and monitors departmental goals and objectives which are consistent with the organization-wide strategic objectives.
• Identifies opportunities for improvement and resolves complaints received from patients, physicians, staff and employees – focusing on quality patient outcomes and organizational values (ICARE).
• Develops, monitors and participates in Performance Improvement Processes.
• Consults with the Executive Team regarding Case Management, Social Services and Denial Management operations.  Informs and updates CFO on issues that impact the strategic goals and objectives of the facility.
• Conducts monthly staff meetings.
• Reviews and revises departmental policies and procedures annually.
• Reviews and updates the Utilization Review Plan annually.  Ensures the plan is reviewed and approved by the appropriate hospital committees, state and federal agencies annually.
• Attends scheduled meetings of the Senior Leadership, Combined Leadership, Nursing Leadership, UR Committee, TJC Taskforce, Managed Care Taskforce, Clinical Best Practice, Revenue Management, CDMP Taskforce, Home Healthcare Advisory Council and other committees or task forces as required.
• Interfaces with external agencies. (HHC, SNF, DME, PRO, Ancillary Agencies, DCFS, Insurance Reviewers, etc.)
• Meets with various department directors to facilitate a collaborative, cost effective integrated healthcare delivery system.
• Trains the CM Physician Advisor to the UR Plan and responsibilities.
• Monitors clinical denials portion of the denial management program. Oversees the RAC/Nurse Auditor’s activities including auditing, education and feedback to team departmental and interdepartmental members and physicians.  Escalates issues to Directors and CFO as appropriate.
• Participates in the organization’s special projects and activities involving community activities and other hospital.
• Provides education via the education department to the Internship Program, New Managers Education Program, etc.
• Completes all duties as assigned by the CFO/Executive Team.

Qualifications

 

What You Will Need:

• Minimum of five years of clinical nursing experience required.
• Five years of experience as Case Management Manager or Director is required.
• Current Florida RN license required

Job Summary:

Directs supervises and evaluates the operations of the Case Management, Social Services and Denial Management/Recovery Audit Contractor (RAC)/Nurse Auditing programs for Florida Hospital-East Region.  Is responsible for annual budget development, new program development, establishing department policies and procedures, department goals and objectives.  Maintains quality assurance.  Promotes and coordinates department Quality Improvement and coordinates activities with other departments to provide and maintain optimal standards of patient care.  Responsibilities include the assurance that the staff adheres to the Florida Hospital – East Region’s Corporate Compliance Program, to the rules and regulations of all local, state and federal guidelines and to the standards of accrediting bodies.

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

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