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Director Case Management in Tampa, FL at AdventHealth

Date Posted: 2/7/2019

Job Snapshot

  • Job Schedule
  • Location:
    Tampa, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Case Management
  • Travel
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Carrollwood

Job Description

Director of Case Management PRN AdventHealth Carrollwood

Location Address: 7171 North Dale Mabry Highway Tampa, Florida 33614

Top Reasons to Work At AdventHealth Carrollwood
  • Family-like culture
  • Teamwork driven both inter Dept and multidisciplinary
  • Positive working climate to support a well-balanced work life balance
Work Hours/Shift:
Full Time Days
You Will Be Responsible For:
  1. Oversees the daily operation of the Case Management Department.
    1. Supervises daily review activities within scope of the Hospital-wide Utilization Review/Performance Improvement Plans.
    2. Makes recommendations for hiring, training and development.  Supervises, and initiates or recommends personnel actions for the CM Staff.
    3. Develops and implements ongoing modifications of CM systems, both computerized and non-computerized.
    4. Ensures that UR plans are updated on an annual basis in compliance with State and Federal requirements as well as Hospital policy.
    5. Acts as liaison to Administration, Medical Staff, and outside agencies relative to UR, Case Management activities.
    6. Recommends evaluation studies, clinical monitors, UR, Case Management topics for consideration.
  1. Assists in the assessment of anticipated impact of external regulations and cost-containment efforts related to Utilization Review, Case Management.
  1. Oversees Case Management activities.
    1. Supervises Case Managers to ensure timely completion of all Utilization Management, Case Management activities and projects.
    2. Oversees effectiveness of Physician Advisors work activity.
    3. Assists CMs, RNs in making level-of-care determinations and Notice of Non-Coverage decisions.
  1. Responsible for providing a framework to effectively manage a patient's care from onset of illness to return to health (or stabilization of illness) across the continuum of care.
    1. Development of a database that can be used to improve specific patient care processes.
    2. Documentation of programs’ success in terms of organizational and patient outcomes.
    3. Defining consistent expectations for the healthcare system.
    4. Movement of patient through the healthcare system in anticipation of transfer back to community.
    5. Collaborates with primary care physician to assess patient's need, establishes a plan which identifies and recommends appropriate resources, oversees implementation and coordination of plans.
    6. Monitors and evaluates effectiveness of patient plans.
    7. Determines reimbursement for healthcare services using knowledge of third-party payer coverage to effectively allocate resources based on patient’s needs and to maximize reimbursement.
    8. Monitors patient’s progression through plan of care; recommends alternative settings where appropriate.
    9. Actively participates in continuing care rounds.
    10. Facilitates patient discharges/transfer, ensures that required paperwork is completed.
    11. Recommends changes/improvements to healthcare system; e.g., new program development, network opportunities.
  1. Collaborates with Finance, Clinical Services and Medical Staff to maintain a system of documentation that accurately reflects patient care and resources applied to meet clinical outcomes.
  1. Implements DAP to yield CC capture rate at benchmark goals.
  2. Serves as an organizational resource in patient outcome plan management and cost effectiveness in clinical care.
  3. Assists in the development of systems to reflect patient care delivered throughout the Organization continuum (acute in–patient care, transitional care, outpatient and community/home care).
  4. Promotes the achievement of optimal, quality patient outcomes in relation to clinical care and cost effectiveness through the development/monitoring of integrated patient outcome plans across the continuum.

What You Will Need:
  • Five years of relevant progressive work experience in clinical healthcare, including direct experience in quality assessment and resource management preferred.
  • Strong professional, organizational, and interpersonal skills required for effective and creative leadership in working with all levels of the Organization including physicians, committees, senior management, and trustees, as well as patients and their families. 
  • Ability to lead, support and build on current efforts of various groups working within the department's scope of work.
  • Ability to extensively communicate with outside agencies, third-party payers and regulators.
  • Prior management experience in hospital-wide quality resource management programs, monitoring and evaluation, experience in ensuring compliance with Federal and State regulations and statutes relating to healthcare delivery.
  • Possess good analytical and problem-solving skills.  Ability to work with computerized clinical information systems.  Initiative, flexibility, integrity and diplomacy is desirable.
  • Function independently under the guidance of the SVP within the broad scope of department and organization-wide policies, practices and common goals.
  • Generally refers specific problems to SVP only when the clarification of operating policies and procedures may be required.
Job Summary:

Serves as the Director of Case Management responsible for implementing and supervising the day-to-day operation of the Case Management and Utilization Management Programs of the Hospital.  Manages activities necessary to ensure appropriate utilization of the Hospital and its resources while maintaining optimal achievable standards of patient care.  Maintains the strictest confidentiality of all patient information.

Promotes the concept of cooperation and develops open lines of communication with department employees, patients, visitors and other personnel within and outside the Hospital.

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

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