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Medical Management Care Manager in Maitland, FL at AdventHealth

Date Posted: 2/7/2019

Job Snapshot

  • Job Schedule
  • Location:
    Maitland, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Population Health
  • Travel
    Yes, 25 % of the Time
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Corporate

Job Description

Medical Management Care Manager AdventHealth Corporate
Location Address: 101 Southhall Lane Maitland, FL 32751
Top Reasons To Work At AdventHealth Corporate
  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential
Work Hours/Shift:
  • Full-Time, Monday – Friday
You Will Be Responsible For:
  • Provides guidance and acts as a liaison for the team of Operations and Care Managers team, as well as customers both intra-department and inter-departmentally.
  • Identifies high-risk members, monitors, assesses, and evaluates health care needs, collaborates and coordinates care and services between healthcare providers and care managers.
  • Organizes, distributes and communicates daily census reports, tracking and trending reports, and identifies gaps in transitions of care.
  • Adheres to case management standards of practice for care management promoting quality care and cost-effective outcomes that enhance physical, psychosocial and vocational health of individuals.
  • Performs and provides oversight for activities involved in the Operations and Utilization Management team including clinical reviews, appeals reviews, Care Management activities, and quality assurance activities.
What You Will Need:
  • Current Active State of Florida license as a Registered Professional Nurse.
  • Graduate of a school of nursing – minimum Associates Nursing Program
  • Experience in clinical nursing with a minimum of three years’ experience
  • 3-5 years’ experience in any one of the following areas:  utilization management, insurance/managed care industry, case management
  • Comprehensive knowledge and understanding of chronic and acute disease conditions, management, and treatment
  • Comprehensive knowledge and understanding of utilization management criteria
Job Summary:
The function of the Utilization Management Care Manager is to coordinate care, educate members and providers, and provide interventions within the scope of case management practice that have direct influence on clinical and financial outcomes.  Responsibilities includes identification of high-risk patients, assessment of healthcare needs, collaboration and coordination with health care providers, quality management activities, process review and development, clinical reviews and reports to distribute care across teams, and coordination and support of inpatient and outpatient utilization management activities. Participates in the process to identify and facilitate options and services for meeting individuals' health care needs, while decreasing fragmentation and duplication of care and enhancing quality and cost-effective clinical outcomes. Shared accountability for cost savings and meeting department utilization metric goals. Responsible for ensuring efficient care management outcome measures and compliance with regulatory requirements.  Attends pertinent seminars, workshops and professional meetings to maintain up-to-date knowledge base as it relates to the Care Management. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

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

Location | Organization | Category | Job Function