Responsible for directing all activities within a department, developing and maintaining quality-improvement programs, collaborating with physicians and medical staff to ensure service expectations are being met and directing the workflow of Case Managers. Serves as a resource for the case management team and other departments.
Job Specific Duties
Responsible and accountable for all operations within areas of oversight.
Ensures care delivery processes are at the cutting edge of clinical quality and safety. Supports safety culture initiatives and ensures high level of compliance with regulatory standards, CMS, and public-reporting indicators of clinical practice.
Ensures case management process is initiated effectively across the organization, and patients receive the appropriate level of care across the continuum.
Data analysis related to Case Management metrics; develops, implements, and monitors action plans related to denials, avoidable days, LOS, and other identified case management metrics.
Leads and directs process improvement initiatives and other safety programs; ensures applications and concepts are standardized and reliable processes and sustained in the department. Supports process improvement and incorporates science principles into quality/process improvement activities while working with leadership ensuring application of evidenced based practice in the departments.
Accountable for patient satisfaction and employee engagement scores. Supports patient/family experience, initiatives, and leading practices. Promote and maintain positive relations with patients and their families, as well as, other healthcare organizations.
Strategically positions the departments to react effectively to unplanned circumstances, demands, and challenges facing the industry while creating revenue enhancements and cost reduction practices. Ensure sufficient staffing to meet patient care needs while monitoring and ensuring compliance with department budgets.
Oversees and supports talent development of the leadership team to ensure succession planning, mentorship, and coaching within departments leading to strategic goal accomplishment. Provides ongoing performance feedback, coaching, and mentoring to leaders and staff.
Bachelor's Degree in Nursing (BSN), Healthcare, Finance, Business Administration, or related field
Registered Nurse Licensure in the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) – maintain active and in good standing throughout employment
3-5 years of managerial and leadership experience in an acute care environment with oversight of clinical departments and teams
Prior experience in leading and implementing large scale projects, system implementation, and organizational change
Master’s Degree – MSN, MHA, or MBA
NE-BC or NEA-BC and/or CCM
InterQual criteria and Midas Information systems
ICD9, CPT, HCPCS APC, DRG, Revenue Codes and Status indicators related to ambulatory and outpatient reimbursement.
Prior experience with auditing and internal controls review in a healthcare revenue cycle.
Prior experience with various technologies, hospital information systems, and other tools used in patient financial services, particularly Cerner.
Nicklaus Children’s Health System, is the region’s only healthcare system exclusively for children. In addition to Nicklaus Children’s Hospital and a growing number of outpatient centers located throughout the tri-county area, the health system includes Nicklaus Children’s Hospital Foundation, the organization’s fundraising arm; Nicklaus Children's Pediatric Specialists, a nonprofit physician practice subsidiary; a management services organization, and an ambulatory surgery center. Our vision is to be where the children are. Ultimately, this means being there through all stages of health and life, both physically and emotionally. To be a trusted partner to children and their families, not only in times of illness, but throughout their life journey. Our mission is to inspire hope and promote lifelong health by providing the best care to every child.