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AdventHealth Registered Nurse Case Management Manager Full Time Days in Ocala, Florida


"Manager - Case Management Full Time Days" AdventHealth Ocala

Location Address: 1500 SW 1 st Ave Ocala, Florida 34471

Top Reasons To Work At AdventHealth Ocala

  • Horse Capital of the World

  • Driving distance to Gainesville, St. Augustine, Orlando, Tampa, Sarasota

  • Part of the community since 1898, providing healthcare to Marion County for over 120 years

  • Florida Hospital Ocala offers a broad spectrum of services, with programs that are nationally recognized and accredited

  • Spectacular springs throughout the county

Work Hours/Shift:

Full Time Days

You Will Be Responsible For:

  • Strives to provide excellence in service to hospital staff, patients and families.

  • Reviews current professional standards for each program and makes recommendations for changes in policy, procedures, equipment, and assignments.

  • Preparation of deliverables such as Avoidable Days, Denial, and DRG Options reports for the meetings as well as any other necessary reports.

  • Manages the staff activities to ensure fulfillment of the institutional and program objectives.

  • Interviews for positions and makes recommendations for hiring and terminating staff.

  • Conducts 30 & 60-day new employee assessment, administers 90 day competency evaluation.

  • Daily oversight of utilization review activities to ensure compliance with Medicare and Medicaid as well as contractual agreements with Managed Care contracts.

  • Ensures staff assign working DRG’s to establish geometric mean LOS, collaborate with CDIS staff to update working DRG as needed throughout the patients stay.

  • Operates within designated budget to maintain expenditures within allocated funds, initiates actions to correct or seeks approval to maintain budget variances.

  • Utilizes InterQual®ISD & or Milliman criteria to ensure appropriate level of care settings.

  • Develops and implements policies and procedures that guide and support the provision of case management services and social work services across the continuum of care.

  • Identifies and assists staff to maintain current information on community resources.


What You Will Need:

  • Graduate of an accredited School of Nursing.

  • Two years in Case Management or like experience

  • One-year experience at a supervisory/manager level.

  • Current license of RN in Florida or licensure from another state with verification of application of eligibility for Florida licensure by endorsement.

  • BSN/MSN or health related degree preferred

  • ACM certification or CCM preferred, must obtain within one year of hire date

  • Application of InterQual® and or Milliman® Criteria set.

  • Assessment skills and knowledge application for all ages from newborn to geriatric.

  • Assessment of appropriate use of hospital services and care coordination.

  • Experience with PC applications required (such as word processing, spreadsheets, and graphics).

Job Summary:

The Manager is responsible for the daily operations, long term planning and budget of the CM department in accordance with the Utilization Management Plan and department policy and procedures. The Manager is responsible for data management and reporting as mandated by Federal, State and Community regulatory agencies including QIO activities and Corporate required reporting. Personnel management and supervision of case management Fosters cooperative working relationship with members of the Case Management team, physicians and patients to provide quality coordination and progression of care activities including: discharge planning & utilization review. Plans, organizes, implements, and evaluates the activities of the Case Management Department, which include the functions of utilization management, discharge planning, social work services, and spiritual care as well the integration of these functions with fiscal services. Works closely with directors, physicians, nursing/clinical staff, and fiscal services to ensure that services provided by the department serve to optimize quality of patient care, utilization of hospital resources, and reimbursement by third payers.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.