Senior Manager Utilization

Senior Manager of Utilization -AdventHealth Well65+

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Paid Days Off from Day One

• Student Loan Repayment Program

• Career Development

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Monday-Friday

Shift: 8:00AM-5:00PM

Location: Hybrid (Travel across all Well 65+ practices and will be remote when not at a practice)

The role you'll contribute:

The Senior Manager of Utilization will oversee ED, Inpatient, and Specialist utilization, and manage care management outcomes. The Senior Manager of Utilization will provide support, training and guidance to the RN on care management duties/assignments. The Senior Manager of Utilization will be responsible for auditing the Transition of Care (TOC) process to ensure quality and consistency. The Senior Manager of Utilization will liaise with RN Case Managers to assist primary care physicians, social workers, and other care providers with the development of care and chronic disease plans. This position will be responsible for the oversight and implementation of the chronic disease Care Management (CM) programs within the practices. The Senior Manager of Utilization requires strong management and leadership skills, and will require travel

The value you'll bring to the team:

• Develops and implements case management programs and education, including utilization review, transitions of care, disease management, population health management, and patient education.

• Analyzes KPIs for opportunities for improved utilization, enhanced cost effectiveness, and providing quality patient care.

• Develops collaborative relationships with cross-functional leadership and key stakeholders to meet company goals.

• Assesses and improves the department's performance by evaluating operational processes, monitoring performance through analyzing data, and developing attainable annual goals and objectives for department.

• Ensuring compliance with policies and SOPs.

• Performs chart audits to assure quality of documentation and use of appropriate case management processes/protocols.

• Interviewing, hiring, training, and overseeing case management staff and oversight of CM core functions and practice.

• Partners with Practice Managers in holding care managers accountable on performance by coaching and counseling, when necessary.

• Resolves patient needs by utilizing multidisciplinary team strategies.

• Maintains documentation of care management services by auditing patient records. Informs and assists providers to ensure appropriate documentation exists to support the care management plan for the patient.

• Provides feedback and advice to help improve the standardized workflows, EMR documentation, and overall care provided to our patients.

• Collaborates with team members/stakeholders to provide a smooth, organized and efficient flow of patients in a systematic approach to provide and coordinate health care services.

• Must work collaboratively with the Providers and care teams within the practices by seeking feedback and implementing most effective processes and procedures to achieve desired outcome.

Qualifications
Qualifications - External

The expertise and experiences you'll need to succeed :

Minimum qualifications :

• Bachelor's degree in nursing with 4+ years of experience.

• Registered Nurse with an active and unrestricted license to practice in the State of Florida.

• Current BLS certification.

• 2+ years of experience in a physician's office, clinical or hospital setting.

• Knowledge of chronic diseases, especially COPD/asthma, diabetes, CHF, and IHD.

• Proficient computer skills to work efficiently with electronic medical records.

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

• Current active RN licensure in Florida

• BLS (Basic Life Support)

Preferred qualifications:

o Experience related to patient education and/or motivational interviewing skills and self-management goal setting.

o Fluent written and verbal skills in English.

• Proven excellent verbal and written skills

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