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Description

Case Manager - South Miami, FL


Job Summary:

Seeking an experienced case manager with +5 years of experience in an acute hospital setting.

 

Qualifications:

  • Experience
    • 5+ years of experience in managed care
    • Substantial clinical experience
  • Education
    • Bachelor's degree (required)
    • Masters (preferred)
  • Licensing
    • Foreign Medical Graduate or Registered Nurse (preferred)
    • CCM (Certified Case Manager) (preferred)
    • ACM (Accredited Case Manager) (preferred)
  • Bilingual (English/Spanish) (preferred)

 

Responsibilities:

  • Performs and documents patient assessment within 24 hours of admission
  • Checks prior authorizations initiative by admitting
  • Knowledge navigating and using payer portals
  • Performs concurrent reviews
    • Contacting all HMO’s on a daily basis and provides clinical information to obtain insurance authorization for the patient’s admission and continued stay
  • Indicates the appropriate level of care and utilization of services needed
  • Establishes criteria for medically necessary services
    • Knowledgeable of Milliman Care and Interqual Guidelines
  • Develops a plan of care for patients from admission to discharge. 
  • Promotes the most efficient and cost-effective use of services
  • Curtails the performance of inappropriate and/or duplicate services
  • Encourages standardization of medical practice patterns
  • Enhances the quality of healthcare
  • Performs concurrent reviews for patients to ensure that extended stays are medically justified and are documented in patient's medical records.
  • Calculates and manages the lengths of stay and continued-stay days for patients.
  • Evaluating the patient’s condition and readiness for discharge planning
  • Develops discharge plans
  • Communicate and assist the physicians in the planning and coordination of patients discharge planning
  • Management of transfer procedures
  • Management of the guardianship process
  • Able to discuss and educate patient/family regarding discharge planning and resources available after discharge. Clearly specifies all the information discussed with the patient and/or family regarding the patient’s discharge plan.
  • Participates in PI programs through the identification of opportunities for improvement, data collection, evaluation of findings, improving the process, applying knowledge and incorporates into practice
  • Scheduling Peer-to-Peer reviews with payors
  • Proactively identifying and resolving issues that could lead to denials

 

Skills:

  • Familiarity with Medhost electronic medical records
  • Extensive medical knowledge
  • Self-driven (work and education)
  • Keeps knowledge up to date by reading literature and participating in outside continued education meetings, training, and conferences
  • Working knowledge of regulatory agencies
  • Excellent human relations and communication skills (verbal and written) to maintain good rapport and effective working relationships with medical staff, nursing staff, and other ancillary department staff throughout the hospital
  • Excellent organizational skills and attention to detail
  • Ability to convey care plan to physicians and the medical team
  • Proficient with Microsoft Office Suite or related software.
  • Integrity

https://casemanagementstudyguide.com/which-case-management-certification-is-best/

Pay

Average Florida Staff Position Pay

$33.61/hour

The average salary for a Case Management is 34% lower than the US average of $45.

Estimate based on Bureau of Labor Statistics data.