Utilization Review Case Management Associate Administrator (RN), Case Management, Full Time, Days

JOB DESCRIPTION

Department : Jackson Memorial Hospital - Utilization Review Case Management Leadership

Address : 1611 NW 12 Ave., Miami, FL 33136

Shift details : 8 : 00 - 4 : 30 PM, Monday - Friday (remote position, must live within one hour from facility)

Why Jackson Memorial Hospital : Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century.

Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida.

We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success.

Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals.

Summary

The Associate Administrator manages a large multi-functional service area to ensure maximum efficiency and responsiveness while adhering to budgeted resource allocations.

Provides direction to a multi-disciplinary, multi-skilled workforce to ensure that services and outcomes comply with standards established by various accrediting, licensing, other regulatory agencies and the Public Health Trust.

Exercises shared responsibility for the development and maintenance of effective working relationships with all disciplines responsible for the provision of service to customers in the Designated Service Areas(s) while conducting business in an ethical manner and respecting customers' rights.

Ensures a single high standard of care regardless of a customer's ability to pay. The incumbent will have a significant role in the administration or preparation of the departments or the organization's budget.

The incumbent may assist and act in a confidential capacity to help manage, formulate, determine and effectuate management process and polices.

The incumbent may attend management meetings and may be involved directly or indirectly in the decision making process around confidential management decisions.

Position requires exercise of independent judgment.

Responsibilities

• Promotes a strong customer service orientation within the Designated Service Area(s) including development and implementation of customer-focused systems, processes and behaviors.
• Establishes systems of accountability for clinical, clerical and support personnel to ensure that customer needs are assessed accurately and serviced in a timely fashion.
• Develops and maintains effective working relationships with all other disciplines responsible for the provision of service to customers in the Designated Service Area(s).

Provides leadership by developing, communicating, implementing and evaluating the mission, goals and objectives of the Designated Service Area(s).

• Ensures that unit specific goals and objectives are consistent with those of the Division, Medical Staff and staff. Demonstrates vision and initiative in directing all aspects of the Designated Service Area(s).
• Is aware of changes that affect the Designated Service Area(s) and takes action, as appropriate, to ensure future success for the Designated Service Area(s) and the Public Health Trust.

Acts as a role model for employees and customers by demonstrating exemplary personal and professional attributes consistent with organizational philosophies.

Analyzes situations and arrives at conclusions which serve the best interests of Designed Service Area(s) and the Public Health Trust.

Develops, communicates, implements and evaluates an on-going Performance Improvement plan for the Designated Service Area(s) consistent with the philosophy of the Executive Performance Improvement Council (EPIC) and the Designated Service Area Performance committee.

Ensures that unit specific Performance Improvement plans are consistent with those of the Division, Medical Staff and the Public Health Trust.

Ensures that Performance Improvement plans are interdepartmental and interdisciplinary and include components which increase customer satisfaction, operating efficiencies and positive customer outcomes.

Provides adequate time and resources so that personnel may participate in Performance Improvement activities.

Demonstrates an empowering management style congruent with the performance and quality improvement philosophy of the Public Health Trust.

Establishes and directs information management systems to obtain, collect, store, analyze, manage and disseminate information to continuously improve customer outcomes and individual Designated Service Area(s) performance.

• Communicates organizational policies and procedures effectively. Assumes primary responsibility for ensuring that the Designated Service Area(s) and the Public Health Trust are kept informed about clinical, administrative and environmental issues and their effect and / or impact on the institution.
• Ensures that information processes are appropriate for the Designated Service Area(s) and compatible with internal and external information systems and standards.
• Uses and analyzes appropriate technology and systems in assessing and conveying information.
• Recruits, retains, evaluates and motivates staff necessary to implement the goals, objectives and responsibilities of the Designated Service Area(s).
• Implements and ensures compliance with job performance standards to assess staff competencies.
• Provides leadership for staff development and ensures staff participation in appropriate orientation, training courses and mandatory educational programs to maintain competency in job skills, knowledge, equipment usage and safe work practices.
• Maintains a working knowledge of laws, policies, procedures and collective bargaining agreements impacting upon employees in the Designated Service Area(s).
• Ensures appropriate staffing mix to meet the needs of the Designated Service Area(s). Facilitates employee empowerment and encourages employee participation.

Delegates tasks while retaining accountability for outcomes.

• Enforces Public Health Trusts personnel policies fairly and consistently and takes progressive disciplinary action for just cause.
• Plans, administers and uses staff, materials and unit facilities appropriately to meet budgetary objectives of the Designated Service Area(s).
• Understands budget development and reimbursement procedures; develops and implements strategies to maintain or increase revenues while controlling expenses.
• Participates with other members of management in developing, implementing and evaluating programs and policies related to the determination, allocation and control of fiscal, human, materiel and informational resources for the Designated Service Area(s).
• Understands and utilizes Public Health Trusts fiscal management tools effectively.
• Develops and manages an Emergency Preparedness Plan consistent with Public Health Trust and community-wide emergency preparedness efforts.
• Participates with the Medical staff and other disciplines responsible for patient care to develop, implement, monitor and evaluate appropriate clinical care to meet the needs of the patients within the Designated Services Area(s).
• Ensures staff participation in an effective and efficient case management system for the Designated Service Area(s). Provides for an effective patient and family education program to meet the needs of the Designated Service Area(s).
• Maintains a working knowledge and understanding of managed care as well as Public Health Trust, local, and national health care delivery systems and ensures that Designated Service Area(s) operates within applicable guidelines.
• Ensures that staff provides for continuity of care, early discharge planning and effective utilization of Public Health Trust and community resources.
• Maintains current knowledge of County, State and Federal guidelines / requirements as they apply to job duties, licenses and certification to ensure the Designed Service Area(s) compliance with regulatory agencies.
• Role models behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
• Performs all other related job duties as assigned.

Experience

• Generally requires 5 to 7 years of related experience.
• A minimum of two years of supervisory experience is required.

Preferred Experience

• Strong clinical background, highly preferred.
• At least five (5) years's experience in utilization review either in a hospital setting, or at a health plan organization, strongly preferred.
• Denials / Appeals experience, highly preferred.
• Strong clinical background with RN license
• Knowledge of CMS regulations, highly preferred.
• Experience in managing a team, including training, mentoring, and performance evaluation.

Education

• Bachelor's degree is preferred; direct experience can be substituted for the degree.
• Master's degree, strongly preferred.

Credentials

• Licensed health Professional (RN, ARNP, MD) is preferred.
30+ days ago