Serves as a change agent to re-structure or improve hospital clinical or operational monitoring activities to reflect the philosophy of the evidence based medicine/disease management/clinical programs initiatives.
Assumes implementation responsibilities for change activities required to re-engineer hospital clinical processes to address resource consumption issues.
Educates Medical Staff and hospital administrative staff concerning current trends in cost/resource management.
Identifies clinical topics for review and analysis by medical staff monitoring committees, based on consistent monitoring of clinical practice patterns, feedback from clinicians and physicians and retrospective data analyses of quality, resource consumption and cost reports at a DRG and physician-specific level.
Develops an active, collaborative, interface and structure with AdventHealth Medical Staff
What Will You Need:
Bachelorâ™s degree in Nursing
Masterâ™s degree in Nursing, Business, or health-related field
Seven to ten yearsâ™ acute care hospital clinical experience
Five yearsâ™ progressively responsible leadership experience
Previous case management, utilization management, or related discipline experience
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:
Current, valid State of Florida license as a registered professional nurse
LICENSURE, CERTIFICATION, OR REGISTRAITON Preferred:
Nursing specialty certification
Case management certification: Accredited Case Manager (ACM), Certified Case Manager (CCM), Board Certified in Case Management (RN-BS)
Under minimal supervision, the Director â“ Care Management - System develops and coordinates implementation of complex hospital strategies, involving physicians and multiple hospital departments, to assure appropriate utilization of hospital resources, appropriate level of care for patients, and appropriate discharge planning. Responsible for assuring appropriateness of patient admissions based on severity of illness/intensity of service criteria. Facilitates case reviews based on medical screening criteria and oversees denial management process to third party payers to ensure optimum reimbursement. Responsible for case management, utilization review and social worker/discharge planning processes for AdventHealth business units. Responsible for building and maintaining positive working relationships with medical staff, external agencies (ECFâ™s, sub-acute facilities, Home Care) and all members of the health care team. Responsible for on-going operations, short- term and long-term planning and development of the outcomes management service area for AdventHealth. Develops and implements state-of-the-art performance improvement and outcomes management programs that enhance the operational, financial, and clinical performance of the organization. Implements and oversees the maintenance and use of databases and systems for measuring, monitoring, and tracking utilization and performance changes. Leads and directs cross-functional teams for achieve results. Works closely with physicians and the campus leadership team on utilization/case management issues. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.