Care Manager

MyCare Medical GroupSaint Petersburg, FL, US

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Job Description

Job Responsibilities

Daily review of Hospital and Skill Nursing Home inpatient list
Case Review forms to UM / Quality Department by 4 : 00 PM New admissions
Daily updates from Hospital and / or SNH Case Managers
To provide information to Hospital and / or SNH Case Manager
To coordinate post in patient admission services and office follow up
To obtain medical records from Hospital and / or SNH for office follow up
Family dynamics and support systems
Coordinate with PCP and Care Team at Facilities any possible admissions and / or ER diversions to a Skilled Nursing Home
Notify Skilled Nursing Home admitting physician and Case Manager of any possible admissions and provide medical information as needed
Maintain appropriate documentation in available systems EMR and any other CM software
Contact high risk patients when they are no shows.
Document in the chart the reason and reschedule
Regular interaction with office Care Team to review elective / future inpatient and outpatient procedures.
Review w / PCP
Review Pre-op clearance w / office staff
Notify UM / Quality Department Director of upcoming inpatient procedures
Review all out of the area admissions and keep a daily report
Notify Medical Economics / Data Department of all out of area admissions
Daily review of office schedules to identify any patients that need Case Management intervention.
Recent Hospital / SNH discharges
Disease Management
Education on Advanced Directives, Community Services information
Case Management System
Maintain most current patients’ information
Tracking system for Hospital / SNH admissions and Disease management
To identify patients for Disease Management and follow up according to protocol
CAD / CHF / COPD / DM / CKD Disease Management
New patient orientation : All HMO Managed Care Advantage new members orientation within the 1st month of enrollment
Completion of : Mini Mental, ADLs screening, psychosocial assessment (See new patient orientation form)
Identification of any transfer for cause members or reallocation cases
To maintain monthly logs

Job Qualifications

Current Registered Nurse

Case Manager will work towards and maintain Case Management Certification

Case Manager will maintain continuing education appropriate for case management and professional licensure

CPR / BLS certification

BENEFITS

Comprehensive benefits package, including Health, Vision, Dental, and Life insurances

FSA and Life Assistance Program (EAP)

401(k) Retirement Plan

Health Advocacy, Travel Assistance, and My Secure Advantage

PTO Accrual and Holidays

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Care Manager • Saint Petersburg, FL, US