Submission for the position: Supervisor of Case Management - Tampa, FL - (Job Number: 882063)
Supervisor of Case Management - Tampa, FL
No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work. (sm)
The Supervisor of Case Management Services is responsible for the supervision, evaluation and direction of the Utilization Compliance and Quality Management process. The position will ensure compliance with the case management program for prospective, concurrent, retrospective and transition to out-patient care coordinating with physicians, hospitals and ancillary care and empowers team members through active problem solving and resource direction.   The position is a resource for difficult or complex case management or discharge planning. The supervisor successfully impacts assigned team and organization by mentoring those who wish advancement and engages in departmental process improvement teams and activities.  In addition, the Case Management Supervisor is responsible for timely completion of documentation audits, and reviewing and mentoring team members to meet and exceed all documentation compliance standards. This position mentors and trains case managers in the completion of timely, accurate monthly reconciliation reports and statistics and functions as an advisor to Physicians and lower level utilization management staff.
Office Location: 500 N. Westshore Monday-Friday:8am-5pm. Some local travel to support team required
Primary Responsibilities:
• Displays decision making based on prior practices or policy, with some interpretation
• Solves problems and/or reviews facts, and selects the best solution from identifying alternatives with the ability to apply individual reasoning to the solution of a problem and identifies and reports processes or procedures that require modification
• Provides assistance with orientation and mentoring of new case managers
• Reviews difficult and/or exceptional preauthorization requests
• Ensures the identification or potential early-discharge to reduce LOS or prevent hospital admissions
• Regular attendance at PCC in assigned region, mentoring lower level case managers; reviews referrals prior to PCC, assists with complicated referral requests and assists with concerns and benefit application
• Manages difficult, complex and catastrophic patients
• Offers resourceful planning of alternative services when a specific setting or service is not available in the admission facility when approached by assigned team members
• Attends and contributes to strategic planning meetings at assigned team clinics as well as to departmental processing improvement meetings
• Oversees telephonic case management staff and UM out patient care coordination staff and ensures compliance with approved standardized guidelines, regulations and contractual agreements
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
• BSN or Associate’s Degree in Nursing
• Professional Nursing Degree with current RN License (in state of employment)
• 5 years of experience in medical or ICU hospital based nursing or case management, discharge planning, utilization review or other cost containment role
• 1 year of supervisory, team leader, or charge nurse experience or one year successful case management experience with WellMed
• Working knowledge of the managed care referral process, case management, claims, contracting, and physician practice
Preferred Qualifications:
• Medicare criteria knowledge
• 5 or more years of supervisory or lead experience
• Sound knowledge of NCQA  and federal regulations
• Ability to interact with professional and non-professional staff regarding healthcare
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN, Case Manager, CCM, BSN, Managed care, supervisor, manager, Medicare, clinical, referrals, leader, WellMed, Tampa, Brandon, Clearwater, FL, Florida
Case Management
US-FL-Tampa
US-FL-Lutz, US-FL-Brandon, US-FL-Clearwater, US-FL-Largo
WellMed Medical Mgmt, Inc
Aug 12, 2020, 8:35:57 AM
Schedule: Full-time Location(s): US-FL-Tampa