Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. Our main campus is located on 20 acres just north of mid-town Miami, and is home to our support departments like Finance, Accounting, Human Resources, Marketing and more. Join us now to do purposeful work with our diverse and respectful team.

Job Title: Case Manager

Job Summary

Essential Job Functions

• Serves as liaison between the patient, patient's representative(s)/family, physician and companies. Keeps all parties abreast as to the coverage provided and any issues
• Ensure timely communication with insurance providers for clinical submission and authorization extensions/denials
• Ensures that each appropriate patient receives a Notice of Medicare Non-coverage letter 48 hours prior to discharge and/or appropriate appeal rights of discharge
• Coordinates care for all patients by obtaining authorization and making arrangements for all specialty consultations
• Obtains authorizations for all durable medical equipment and ensures that the equipment is received by the patient
• Coordinates follow-up services for resident’s post discharge which include but are not limited to follow-up appointment dates/times and home health services
• Ensures that all medications requested are received in a timely manner
• Works closely with the attending physician, primary care physician and facility's care interdisciplinary team to coordinate care for the patient
• Communicates any issues or concerns regarding coordination of care and/or any appeals to the patients interdisciplinary team
• Coordinates safe transition/discharge planning and arrangement for
• Work closely with Social Worker to ensure the discharge setting is appropriate for the patient; gives the patient and/or family appropriate notification of discharge and explains the discharge appeal process to patient and/or family
• Communicate with the Admissions Department regarding any changes in payor source, status or levels of care.
• Completes all necessary forms and informs all appropriate parties of any changes or dis-enrollments
• Participates in interdisciplinary team meetings and weekly Utilization Review Rehab meetings and any other required meetings as necessary and provides accurate patient information
• Completes special projects as assigned
• Oversees the Case Manager Assistant and provides the support and guidance needed
• Meets with liaisons weekly to give updates, request level increases as needed and discuss safe transition/discharge needs for each of their patients
• Assists the Admissions Department in obtaining initial authorizations and requesting extensions of authorizations within Douglas Gardens Hospital as needed

Job Requirements

Education:

• High School degree or equivalent required
• Bachelor’s degree in Social Work or related field, RN or LPN licensed to practice in the State of Florida preferred OR
• Equivalent experience

Experience:

• 1-year experience working in a social service program for the elderly is
• A good working knowledge of community agencies serving the elderly

Licenses/Certifications:

• If LPN or RN, current LPN/RN license by the Florida State Board of Nursing
• Must have Florida Driver’s License, insurance and have access to automobile for

Abilities Required

• Excellent communication and interpersonal skills
• Knowledge of Dade County streets
• Ability to deal with physical and emotionally frail, elderly and/or disabled persons
• Ability to get in and out of the buses constantly to assist passengers
• Operates equipment to assist disabled persons
• Sensitivity when working with impaired elderly patients is required;
• Must have good interpersonal skills and ability to work with staff, patients and providers of diverse ethnic
• Must be organized and demonstrate good
• Must have good communication skills in English. Knowledge of Spanish may be required.
• Must be able to demonstrate good judgment regarding personal and patient safety

Functional Demands

Environment Work Conditions:

• Normal working condition with adequate lighting and ventilation

Infectious Material Exposure:

• May experience exposure to a variety of infectious material/illnesses in home/community settings. Must be able to recognize potential or actual hazards and deal with them in an appropriate manner.

Organizational Expectations

• Ensures that resident’s/patient’s rights are adhered to
• Demonstrates professionalism and accountability
• Demonstrates a caring attitude consistent with Miami Jewish EmpathicareSM toward MJH residents, patients, family members, employees, and other facility guests
• Demonstrates excellent communication skills
• Ensures confidentiality and security of patients’ medical information
• Identifies and utilizes appropriate channels of communication
• Able to speak, read and write English
• Able to think and act calmly to meet unusual occurrences of the job
• Adheres to the organization’s Mission, Vision and Values
• Participates in departmental activities, meetings and in-services and follows established guidelines
• Maintains a safe working environment

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

We believe in the power of empathy, the value of relationships and the importance of a life well-lived. Come see why Miami Jewish Health is unlike anywhere you’ve ever worked before. We offer competitive compensation, medical/dental/vision coverage and a 403(b)-retirement savings plan for eligible full and part-time positions, free on-campus parking, an onsite fitness center and more.

Miami Jewish Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.