Manager- Care Coordination, Case Management

Education Qualifications

• Bachelor’s Degree Nursing

Licenses and Certifications

• Registered Nurse
• Accredited Case Manager
• Certified Case Manager

Experience Qualifications

• Five (5) years of clinical experience.
• A minimum of (5) years case management experience may substitute for the degree.
• 2 years in an acute care leadership position preferred.
• Certification as an Accredited Case Management or Certified Case Manager required within 3 years of assuming position.

Skills and Abilities

• Experience using electronic medical records, electronic post-acute referral systems.
• Knowledge and experience using Microsoft Office products.
• Demonstrates ability to lead teams.

A Brief Overview
Under the administrative supervision of the Director of Case Management, responsible for leadership, education, and communication incorporating best practice case management methodologies in the acute care setting that advance plans of care and promote safe discharges into the community. Manages the daily activities of the Care Coordinators to ensure care progression and successful delivery of discharge planning and readmission prevention services. Develops and implements tools, processes and systems that support efficient and effective delivery of case management services. Facilitates appropriate and effective use of healthcare resources resulting in safe, high-quality, cost-effective outcomes for the patient. Collaborates with Medical Staff and Hospital Leadership to actively contribute to organizational goals including quality care, resource management, patient experience, and financial performance. Responsible for 24 hour administration of services. Interviews, hires, schedules, assign work to and evaluate the work performance of employees supervised. Responsible for performing job duties in accordance with the mission, vision, and values of Tampa General Hospital and the principles of quality improvement.



What you will do

• Demonstrates current knowledge and level of expertise to develop the procedures required for an efficient, effective care coordination program, to successfully manage the implementation of that program and concomitant activities of the Care Coordinators in a fast paced, dynamic environment. * Able to perform the key functions of the care coordinators to include, care progression, discharge planning, case management and concurrent appeal of denials. * Maintains current knowledge of all local, state, and federal regulatory requirements related to care coordination responsibilities. * Has an understanding of utilization management guidelines used to evaluate patient care and status.
• Leads and participates in departmental and organizational performance improvement activities including the utilization of variance and denial data to assist hospital leadership in identifying opportunities for improvement. * Assesses the quality of work performed in the department, providing feedback to employees with the goal of continuous improvement.
• Serves as a resource to staff in cooperation with Denials Manager to manage and/or resolve issues related to utilization management, case management, simple discharge planning and concurrent appeal of denials. * Completes necessary research to gather appropriate details/information prior to making decisions when complex issues are presented.
• Submits biweekly performance management report, maintaining productivity at approved standards.
• Develops effective processes to ensure accurate and timely admission and continued stay reviews, appropriate authorizations for care and quality communication with payers and caregivers. Positive impact on revenue is demonstrated by the successful fulfillment of these duties.
• Works closely with Denial Manager/ Manager Utilization * Review to review denial and variance data and develop appropriate action plans. Reports progress as required meetings.
• On an on-going basis, ensures staff adherence to the guiding principles of Showtime and competence in the AIDET model as evidence by patient satisfaction scores. * Takes corrective action when staff members deviate from the guiding principles of Showtime or the AIDET model.