Job Description

•    Ability to communicate effectively with diverse populations

•    Ability to function in a stressful and fast-paced environment

•    Interpersonal skills that promote teamwork

•    Critical thinking and problem-solving skills

•    Knowledge of and ability to utilize in-house and external resources

•    Flexibility in prioritization

•    Ability to multitask

•    Effective organizational skills

•    Proficiency in the daily use of standard office equipment such as computer, phone, fax, pager, copier etc. and skill in utilizing Microsoft Word and Outlook tools

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

Demonstrates, through behavior, Florida Hospital’s core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork.

*          Uses established medical necessity criteria as described by policy to conduct screening for medically appropriate admissions. Escalates cases as appropriate to Care Management Director/Manager.  Utilizes information obtained from information systems to accurately assess patient clinical needs and treatment if available and appropriate.

*          Provides updates to the ED and/or Observation clinical team regarding Care Management involvement with the patient during the patient’s visit.

*          Works as a resource to the ED and/or Observation clinical team as needed.

*          Acts as a resource and provides staff and physician education related to resource utilization, medical necessity, and federal regulation and guidelines.

*          Works with the ED and/or Observation team to achieve optimal patient flow/throughput to enhance continuity of care, smooth and safe transition, patient satisfaction, and patient safety. 

*          Communicates effectively with physicians to obtain necessary information to complete all medical necessity reviews as required to prevent unnecessary delays and denials of service. Participates with the healthcare team regarding the patient’s treatment plan; may communicate with patient/family as needed.

*          Refers and may assist the Social Worker for follow-up as needed. 

*          Responds to processes to identify patients with frequent ED visits and/or readmissions to maintain and enhance the plan of care.

*          Utilizes thorough knowledge of various computer/information systems to perform assigned duties.

*          Documents activities, including clinical assessments and discharge plans in a thorough and timely manner or per Care Management Department policy.

*          Thoroughly and efficiently provides information through documentation for continuity of care.

*                Performs other duties as assigned by Care Management leadership