Director, Case Management- Fulltime, Days- Jackson West Medical Center

Miami, FL Full-Time JW-Case Management

Summary

The Director of Case Management directs the day-to-day operations of the case management area, including case management of inpatient, outpatient, mental health and revenue cycle.

Responsibilities

Provides leadership in managed care operations for the Jackson Health System. Directs the Case Management, Utilization Management, Disease Management and Renal Management Programs. Develops, implements and manages the PSN Disease Management Program. Develops, implements and manages the Medipass Disease Management Program for Diabetes, CHF, Hypertension, and Asthma. (Pfizer). Develops, implements, and manages the CAP Disease Management Program. Develops, implements and manages the SFCCN AIDS DMI Project for Miami-Dade County. Directs and manages the concurrent review process for PSN patients within the Jackson Health System. Provides leadership regarding PRO activities, Clinical Compliance Program and Medicare 7th Scope of Work. Oversees prospective payment systems related activities for both inpatient and outpatient care. Co-Directs the countywide Medical Management Program during disasters. Directs and manages the Medical Foster Care Case Management Program. Role models behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). The leader understands and adheres to JHS compliance standards as they appear in the Code of Conduct, Compliance Policies, and all other JHS Policies and Procedures and supports the commitment of JHS in adhering to federal, state and local laws, rules and regulations governing ethical business practices for health care providers by demonstrating knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family and organization information. The leader further understands that JHS is committed to its role in preventing health care fraud and abuse and complying with applicable state and federal laws related to health care fraud and abuse. This commitment is supported and enabled through an anonymous hotline which serves as one of several mechanisms for reporting suspected fraud, waste and/or abuse, as well as other compliance related issues. The leader to report through any of the reporting mechanisms (e.g., anonymous hotline, supervisor, Compliance Officer) any suspected health care fraud, waste and/or abuse as well as other compliance-related issues. Performs all other related job duties as assigned.

Experience

Generally requires 7 to 10 years of related experience. Management experience is required.

Education

Bachelor's degree in related field is required. Master's degree is strongly preferred. Employees hired into this position before January 2017 are grandfathered in to RN requirement.

Skill

General Competencies: Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment. Knowledge and skill in use of job appropriate technology and software applications. Management Competencies: Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources. Skill in monitoring/assessing the performance to make improvements or take corrective action. Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. Ability to plan, implement, and evaluate programs. Ability to establish goals and objectives. Ability to recognize, analyze, and solve a variety of problems.

Credentials

Valid Florida RN license is required. Case Management certification is preferred. Employees hired into this position before January 2017 are grandfathered in to RN License requirement.

Unit Specific Credential

Working Conditions

Physical Requirements - Job function is sedentary in nature and requires sitting for extended periods of time. Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).

Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).