Care Management Manager

Case Management Society of America (CMSA) ®; Daytona Beach (FL); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Care Management Manager to oversee daily operations and ensure compliance with regulatory standards. This role involves coordinating care for patients, implementing strategies to enhance customer experience, and collaborating with an interdisciplinary team to improve patient outcomes. Join a community that values your unique experiences and supports your professional growth while making a positive impact on patient care. This is an exciting opportunity to thrive in a supportive environment focused on holistic well-being.

Benefits

Benefits and Paid Days Off from Day One

Paid Parental Leave

Whole Person Well-being and Mental Health Resources

Qualifications

• 3+ years of direct Care Management experience in an acute care setting.
• Understanding of CMS Conditions of Participation and medical necessity.

Responsibilities

• Coordinate daily operations of the Care Management department.
• Ensure compliance with regulatory standards and documentation.

Skills

Care Management

Utilization Management

Patient Coordination

Regulatory Compliance

Data Management

Education

Bachelor's degree in Nursing or Social Work

Master's degree in Nursing or Social Work

Job description

All the benefits and perks you need for you and your family:

• Benefits and Paid Days Off from Day One
• Paid Parental Leave
• Whole Person Well-being and Mental Health Resources

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full-time, Exempt

Shift: Days, Monday - Friday

Location: AdventHealth Daytona Beach – 301 Memorial Medical Parkway, Daytona Beach, FL 32117

The role you’ll contribute:

The Care Management Manager is under the general leadership of the Care Management Facility Director and has the responsibility of the departmental daily operations and supervision of team members.

The Care Management Manager is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, Social Services implementation of processes based upon data management, accountability for Length of Stay, Excess Days, Avoidable Days, Readmission Prevention, and Discharge Planning. In addition, the Care Management Manager is responsible for department engagement, customer experience, compliance of regulatory standards, and employee evaluations. The Care Management Manager supports professional and collaborative relationships with the Interdisciplinary Team to sustain process improvement and attain hospital metrics.

The value you’ll bring to the team:

• Supports the daily operations of the Care Management department (both Inpatient and Emergency Department settings)
• Implements Corporate Care Management strategies
• Implements strategies with a focus on customer experience
• Ensures documentation compliance of the Care Management department (Discharge Planning Evaluation, IMM, MOON, Patient Choice, etc.)
• Identifies and utilizes resources to support information sharing amongst staff
• Actively participates in daily Multidisciplinary Rounds ensuring staff participation on their assigned units to discuss transition of the patient to the post acute setting and barriers to the plan
• Assures staff documentation is completed per guidelines as evidenced by appropriate monitoring techniques, coaches staff as needed
• Assures patients are routinely assessed for post-hospital needs and documentation occurs within 1 calendar day of patient admission
• Advocates and escalates pace of care delays
• Assures discharge plans are developed in collaboration with patient, family caregivers, care team and payor
• Assures effective discharge planning to meet patient needs, meet regulatory requirements and achieve organization objectives related to readmission reduction
• Supports implementation of processes as directed by system for identification of at-risk populations and acquires necessary resources/services to improve patients' chances of successful self management
• Coordinates and leads family meetings and patient/family and care team meetings as needed
• Strives to meet all key performance indicator (KPI) targets
• Assesses, develops, implements, monitors processes that impact patient outcomes
• Seeks opportunities for improvement in quality of care/services
• Reports pertinent quality/risk issues to appropriate individuals, departments and/or committees in a timely manner
• Monitors and documents activities ongoing to substantiate the effectiveness of care management activities to achieve compliance with external agencies
• Collaborates with outside agencies to guide the handover of patients to the post-acute setting
• Escalates operational and/or financial concerns to the Physician Advisor(s) as appropriate
• Participates, as needed, in hospital/medical staff meetings to review patients meeting criteria related to high dollar/extended length of stay and/or difficult placement maintains meeting minutes as appropriate
• Communicates and collaborates across the Care Management team in the areas of data and information management, performance improvement, care coordination, care transition management, medication management, and social services

The expertise and experiences you’ll need to succeed:

Minimum qualifications:

• Bachelor’s degree in Nursing or Social Work
• State of Florida or Multistate Registered Nursing License (if BSN)
• Three (3) or more years direct Care Management/Utilization Management experience in an acute care setting
• Understanding of core Care Management principles and CMS Conditions of Participation
• Knowledge of medical necessity for appropriate patient status and level of care
• Understanding and ability to implement mitigation techniques to attain hospital metrics
• Front line experience with Joint Commission surveyors

Preferred qualifications:

• Master’s level degree in Nursing or Social Work
• Licensed Clinical Social Worker (LCSW)
• RN-BC Certification in Care Management
• Two (2) or more years of supervisory level of reponsibility

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.