AddressThe Manager - Case Management & Utilization Review is responsible for implementing and supervising the day-to-day operations of the Case Management, Utilization Review, and social work programs in the hospital. The position involves front line daily work as a case manager and engages patients, families and the clinical team to assure patient assessment and discharge planning is a continual process. The position works with post-acute services in transitioning patients to the next level of care. The Manager - Case Management & Utilization Review is responsible for managing referrals to Jay Hospital's Skilled Care Program and building relationships with outside referral sources. The position manages activities necessary to ensure appropriate utilization of the hospital and its resources while maintaining optimal achievable standards of patient care. Specific management of the outpatient Case Management includes emergency department Case Management. The role collaborates with staff, post-acute services, patients, families, insurance companies, etc. The role must maintain the strictest confidentiality of all patient information. The position collaborates daily with the other case managers to focus on tactics towards meeting patient, physician and organization needs and initiatives, while adhering to the values of Baptist Health Care including ownership, integrity, compassion, excellence, and service.
Responsibilities
• Directs, coordinates, and provides Case Management to patients and uses the approved discharge planning software to document assessments, interventions, and internal communication.
• Serves as patient advocate by acting as communication link between the clinical team and external partners.
• Identifies cases requiring intervention and proceeds as necessary in a timely and effective manner.
• Facilitates interdisciplinary discharge planning meetings and family meetings.
• Maintains schedules to ensure adequate staffing for assigned facilities and provides coverage in the case of an emergency. Accepts responsiblity as the exempt leader for operations as needs arise.
• Discusses assessment findings and patient status with physician and/or treatment team to maximize outcomes.
• Responsible for preventing delayed discharges of observation patients.
• Completes Case Management assessment of patients and support systems in order to facilitate the most appropriate and timely transition plan.
• Interacts, communicates, and intervenes with multidisciplinary healthcare team in a purposeful, goal-directed fashion. Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization and discharge planning.
• Consistently maintains a professional commitment to institutions and department's goals and objectives. Demonstrates flexibility to the department's needs in relation to floor and work schedule and any other internal and external demands on the department. Continually shows commitment to the department by extending one's self when the need arises.
• Maintains current knowledge of Case Management, and discharge planning, as specified by federal, state, and private insurance guidelines.
• Is responsible for department's operational excellence; ensures department delivers quality services in accordance with applicable policies, procedures, and professional standards.
• Manage team members which include orientation, development and evaluation of personnel, and monitoring the provision of delivering quality services. Participates in the recruiting, interviewing and selecting of team members following policies, guidelines and applicable laws. Evaluates their performance relative to job goals and requirements. Provides coaching to staff, recommends in-service education programs, and ensures adherence to internal policies and standards.
• Is responsible for the fiscal management of department; assures proper utilization of organization's financial resources.
• Effectively communicates departmental, organization, and industry information to staff.
• Assist in other duties as assigned to support the operational needs of the department and organization.
• May be required to remain on campus immediately before, during, and after severe weather and/or disasters.
• Accurately identifies potential problems affecting the service and implements solutions with follow through and communication.
Qualifications
Work Experience
- 3 years nursing experience in the clinical setting Required
- 1 year Case Management or Utilization Review experience Preferred
Knowledge, Skills, Abilities
- Excellent verbal and written communication skills required.
- Understands health care finance relative to reimbursement for observation, acute and post-acute swing bed status.
- Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking.
- Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis.
Demonstrates flexibility via an ability to adapt to changing priorities and regulation. - Tabulates and presents performance data in leader and swing bed strategic planning sessions.
- Responsible for oversight of the UR program to include annual reports and quarterly meetings with medical staff.
- Demonstrates leadership competencies in communication, decision-making, team development, change management, and operation excellence in leading Case Management, UR and SS services for Jay Hospital.
Education
Associates Degree Nursing Required
Bachelor's Degree Nursing Preferred
Degree or Professional nursing certification in related nursing field within 1 year
Licenses and Certifications
BLS for Healthcare Provider (BLS) American Heart Association Upon Hire Required
Registered Nurse Licensed State of Florida or eligible compact license Upon Hire Required
About Us
Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida.
