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Director Case Management Piedmont - Henry Hospital

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Henry-LogoThe Director of Case Management job is responsible for Organizing, directing and supervising the functions of the Case Management Department, assuring that policy and procedures are followed; proper qualified staffing levels are maintained; supplies and equipment are at sufficient levels; that an efficient department is integrated with the other departments in the hospital. Additional responsibilities for:

 

 

  • The development and implementation of the department’s budget.
  • The director will assure ongoing performance improvement, encouraging educational improvement and assuring employees complete required yearly forums, for reviews and competencies.
  • The director develops, evaluates, initiates, consults and advises the hospital in regard to performance and quality improvement and JCAHO standards related to case management. * The director participates in committees with the hospital medical staff to address and resolve issues.
  • The director continually updates processes for monitoring and managing cases under all types of insurance.

QUALIFICATIONS:

  • Bachelors Degree required; Masters Degree, preferred.
  • Licensure in the State of Georgia as a Registered Professional Nurse is required.
  • Two years clinical experience that directs and evaluates patient care.
  • Previous utilization review experience preferred with knowledge of managed care systems and various review criteria.
  • Knowledge of monitoring and evaluation techniques with previous judgment and decision-making preferably in a utilization management/case management position of two years preferred
  • Ability to analyze and interpret data
  • Knowledge of management practices and procedures
  • Knowledge of budgetary process and/or development
  • Knowledge of administrative and operational process
  • Knowledge of JCAHO regulation
  • Able to demonstrate effective interpersonal skill through verbal and written communication to promote cooperation from health care team, providers, payers, patients and their families.
  • Proficient oral and written communication skills are needed.
  • GA Licensed Registered Nurse required

Cutting-edge facilities, world-renowned medical professionals and genuine compassion and caring. Working at Piedmont Henry Hospital isn't just a job - it's something better. Located in Stockbridge, Georgia, we're a 215-bed, not-for-profit community hospital where leading-edge technology and first-class care come together. We are an excellent destination for individuals who seek a collaborative and supportive environment for career growth.

Located 20 miles south of Atlanta, Stockbridge offers small-town hospitality and excellent public services. You may choose the excitement of life in the cosmopolitan city of Atlanta or select any of its vibrant suburbs. The entire area offers many opportunities to experience cultural diversity, dynamic entertainment and varied recreation.

For more information, please email: This e-mail address is being protected from spambots, you need JavaScript enabled to view it

or visit: piedmonthenry.org to learn more.

Piedmont Healthcare is an Equal Opportunity Employer

Last Updated ( Thursday, 17 January 2013 11:10 )
 

Amerigroup RealSolutions - Case Manager, RN

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JOB SUMMARY: Responsible for managing members experiencing complex or catastrophic illness, high risk pregnancy, injury and/or specialty illnesses such as diabetes, HIV, transplant, behavioral health conditions, etc., to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation.

 

PRIMARY RESPONSIBILITIES:

  1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.
  2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.
  3. Establishes working relationships with referral sources and community resources.
  4. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.
  5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.
  6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.
  7. May be required to conduct field visits.
  8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan
  9. Acts as an advocate for an individual’s health care needs.
  10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services
  11. Participates in Quality Improvement processes and serves on internal and external committees as required.
  12. Other duties as requested or assigned.

 

Education and Experience:

 

Education

Required:

  • Nursing Diploma
  • Associate’s Degree in related Health/Nursing field

Preferred

  • Bachelor’s or Master’s Degree in related Health/Nursing field

Years and Type of Experience

Required:

  • Minimum of three years clinically related experience

Preferred:

  • Experience working on the community level and with community agencies
  • Experience in managed care, case management and discharge planning

Certifications or Licensures

Required:

  • Active licensed RN
  • Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area

Preferred:

  • Certified Case Manager

Language Skills

Required:

  • English

Preferred:

  • Bilingual

Functional Competencies

  • Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad  Ability to review and draft correspondence in email system and word processing systems.
  • Experience working with utilization management data systems

SCOPE INFORMATION

# Direct Reports: N/A

# Indirect Reports: N/A

Budgetary $ Responsibility: N/A

 

Physical Requirements:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
  • Ability to communicate both in person and/or by telephone.
  • Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
Last Updated ( Sunday, 13 January 2013 08:18 )
 

amerisys1

RN TELEPHONIC CASE-MGR SUPERVISOR, WORKERS’ COMP - GEORGIA

USIS/AmeriSys, Atlanta, Georgia  (Dunwoody/Peachtree).  AmeriSys is the medical management division of USIS, Inc., a wholly-owned subsidiary of Brown & Brown, Inc., in business since 1939.  Adding to our wonderful team, we are seeking a Supervisor for Nurse Case-Managers.

 Job Summary:

Experienced Nurse Case-Manager with supervisory experience to assist Program Manager with the supervision of the triage, telephonic nurse case-management staff and utilization review staff for Georgia operations.  Responsible for maintenance of all State of Georgia MCO rules, and company standards.  Assist the Program Manager with QA audits and present minutes at monthly and quarterly QA/UR meetings.  Handle service issues with client claims staff.  Assist as TCM on Workers’ Compensation cases as necessary, for training, and during absences.

Qualifications/Competencies Required:

Registered Nurse – current license – with 3-5 years clinical experience (orthopedic, neurological, neuromuscular, ICCU, industrial or occupational)

CCM or equivalent certification is REQUIRED by State of GA

Case Management experience, preferably Workers’ Comp.

Supervisory experience with effective leadership skills, in support of company culture

Uphold the contractual requirements and standards set forth by URAC

Support the protocol, policies and procedures of the company.

Must work productively and independently to accomplish goals of the job

Possess excellent verbal and written communication skills

Must be technically adept/computer proficient to utilize systems software in efficient and effective manner

Good communication/customer service skills.  Strong organizational skills

Ability to work effectively in fast paced environment, use own initiative, effectively multi-task and prioritize

Ability to work independently, maintaining established standards and procedure

Positive and enthusiastic attitude, self-motivated professional advocating the company culture

In an organization with very little turnover, our people are our most valued asset.  The benefits package, eligible first of the month after 30 days from DOH, includes a 401(k) plan with company match, Employee Stock Purchase Plan, health insurance, disability benefits, life insurance, wellness programs, paid company holidays, 3 weeks paid time off (with incremental increases per tenure).

Salary Range: Competitive, based on experience. 

Please submit your resume and salary requirements to This e-mail address is being protected from spambots, you need JavaScript enabled to view it  

An Equal Opportunity Employer.  Employment is contingent upon successful completion of a background investigation.  No recruiters or agencies should respond to this posting.
 

absolutecare

We are seeking to file a position for a Case Manager.  The current individual in this position has requested a transfer within the organization.  Our practice is rapidly expanding and has a variety of unique programs in which case management is a large component.  We are looking for an experienced individual who has the potential to eventually supervise future case management hires.  This individual will need to work closely with other departments as part of an integrated team.  Excellent salary and benefits for the right candidate.

 

To learn more about AbsoluteCare you may visit:  www.absolutecarehealth.com The preferred method of contact is via email.Case Manager – Job Description


Qualifications:  Experienced Certified Case Manager with a minimum of 3 years’ experience.

The responsibilities include:

Evaluation and modification of existing successful case management program to meet the changing demands for improved quality and cost measures.

Design and implement a grading system to evaluate patient’s needs for case management services, categorizing all patients from 1 to 3, 3 being those with the greatest need for case management services.

Priorities will be given to all patients enrolled in 2 pilot programs under risk contracts.  These 2 contracts have approximately 125 patients total at this time.  All of these patients will be followed intensively to include:

  1. An initial CM plan established within 30 days of enrollment.
  2. A minimum of 1 phone call per week for patients in category 3 and 1 phone call per month for category 2 and 1 patients.
  3. A personal 1 on 1 visit in conjunction with each provider appointment to reassess needs, barriers and facilitate coordination of care.
  4. Frequent contact and coordination between other departments (social work/nutrition/education) to assist with barriers to ongoing care to include financial, food, housing, childcare, transportation, family & home issues.
  5. Follow-up on any missed appointments.
  6. Follow-up on all diagnostic studies, specialty referrals, ER and/or hospitalizations.
  7. Contact with any hospitalized patient and facilitate coordination of care between the office and hospital.  Facilitate hospital follow-up care within 1 week of discharge or sooner as indicated.
  8. A monthly conference with the PCP provider.
  9. Extensive record keeping and data collection on case management effectiveness to include but not limited to:
  • HEDIS measures
  • No Show Rates
  • Adherence to care measures
  • Patient Satisfaction Surveys
    Development of an expanded case management program, eventually assisting with interviewing and supervision of new case managers as part of our continued expansion.
 

ShepherdCenter

CASE MANAGERS
Located in Atlanta, GA, Shepherd Center is a world-renowned, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord or brain injury.  Due to our recent expansion, we have the following full-time Case Management opportunities available:

  • Case Manager - Inpatient ICU/Medical-Surgical
  • Case Manager- Post Acute Brain Injury
  • Case Manager- Post Acute Spinal Cord Injury
Qualifications: Clinical degree in an Allied Health Profession required, Master’s degree preferred *OR* Eligible to sit for the Certification in Case Management (CCM or CMC)/CRRN,CRC,CDMS; experience in healthcare environment (minimum two years preferred). Visit our website at shepherd.org to apply online.  EOE
 
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