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Director Case Management - Health Plans

Job Description

Description:

POSITION SUMMARY\:To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by\:developing, implementing and monitoring the Case Management structure and systems at Health First Health Plans. To promote operational effectiveness while ensuring the provision of appropriate reimbursable care. Responsible for Case Management (including both Complex and Acute/Catastrophic) and Disease Management at the Health Plans. Oversees the implementation and standardization of best practices throughout the Case Management department at the Health Plans and team building that maximizes efficiencies and talents. The Director Case Management at the Health Plans shall possess comprehensive knowledge of the healthcare industry, familiarity with regulatory and accreditation agencies, strategic planning skills and an understanding of the operations of hospitals and healthcare organizations.

Qualification:

QUALIFICATIONS REQUIRED\: Current Florida RN license or MSW required. Bachelor’s Degree from an accredited College or University required, Master’s degree in appropriate healthcare area preferred Certification in Case Management (CCM) preferred. Maintains professional competency by attending managed care seminars, conferences, etc. Minimum of five years of combination of hospital based clinical nursing experience/Utilization management/Quality Management/Managed care experience with minimum of 3 years’ progressive administrative experience. Knowledge of CPT Codes, HIPAA, ICD-9/ICD-10 Codes, Medicare/Medicaid Guidelines, Joint Commission and other regulatory/accreditation agencies. Knowledge of Coordination of Benefits where applicable. (i.e., Worker’s Compensation, Auto Insurance, Short and Long Term Disability). Knowledge of Billing and Claims Processing. Knowledge of alternative treatment options, alternative funding programs and community services and resources. Demonstrated skills in leading and facilitating work efforts. Strong analytical, communication and problem-solving skills. Ability to conduct meetings and speak in front of large groups. A person of good moral character.

Job Requirements

 

Job Snapshot

Location US-FL-Rockledge
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type
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Company Overview

Health First

Health First also works together with other organizations and physicians in our community. Health First donates to the Brevard Health Alliance that provides healthcare services to thousands of underinsured or uninsured Brevard residents who are otherwise unable to pay for healthcare services. Our associates are also actively building a healthier community through volunteering for organizations dedicated to preventing and treating health concerns such as cancer, diabetes, and heart disease. The roots of Health First run deep in Brevard, dating back to 1937 when Brevard Hospital first opened in Melbourne with 27 beds. Now known as Holmes Regional Medical Center (HRMC), the hospital is Brevard's largest, with 514 beds. Cape Canaveral Hospital (CCH) opened in 1962 with 44 beds, and has since grown to 150 beds. Palm Bay Hospital (PBH) opened in 1992 as a satellite of HRMC with 60 beds. Viera Hospital opened in 2011 with 84 all private, in-patient rooms. Learn More

Contact Information

US-FL-Rockledge
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Snapshot
Health First
Company:
US-FL-Rockledge
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Store Type:

Job Description

Description:

POSITION SUMMARY\:To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by\:developing, implementing and monitoring the Case Management structure and systems at Health First Health Plans. To promote operational effectiveness while ensuring the provision of appropriate reimbursable care. Responsible for Case Management (including both Complex and Acute/Catastrophic) and Disease Management at the Health Plans. Oversees the implementation and standardization of best practices throughout the Case Management department at the Health Plans and team building that maximizes efficiencies and talents. The Director Case Management at the Health Plans shall possess comprehensive knowledge of the healthcare industry, familiarity with regulatory and accreditation agencies, strategic planning skills and an understanding of the operations of hospitals and healthcare organizations.

Qualification:

QUALIFICATIONS REQUIRED\: Current Florida RN license or MSW required. Bachelor’s Degree from an accredited College or University required, Master’s degree in appropriate healthcare area preferred Certification in Case Management (CCM) preferred. Maintains professional competency by attending managed care seminars, conferences, etc. Minimum of five years of combination of hospital based clinical nursing experience/Utilization management/Quality Management/Managed care experience with minimum of 3 years’ progressive administrative experience. Knowledge of CPT Codes, HIPAA, ICD-9/ICD-10 Codes, Medicare/Medicaid Guidelines, Joint Commission and other regulatory/accreditation agencies. Knowledge of Coordination of Benefits where applicable. (i.e., Worker’s Compensation, Auto Insurance, Short and Long Term Disability). Knowledge of Billing and Claims Processing. Knowledge of alternative treatment options, alternative funding programs and community services and resources. Demonstrated skills in leading and facilitating work efforts. Strong analytical, communication and problem-solving skills. Ability to conduct meetings and speak in front of large groups. A person of good moral character.

Job Requirements

 
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Director Case Management - Health Plans Apply now