Inpatient Case Manager - Weekend: AvMed Health Plans

Position Summary:

The Inpatient Case Manager will support the Medical Department in achieving clinical quality, efficiency and service objectives by providing initial and concurrent review and coordinating case management of hospitalized Members. Performs on site and telephonic concurrent utilization review on all assigned hospitalized Members, using Milliman. Reports clinical information to the Utilization Manager, Utilization Supervisor, or Medical Director as needed. Works with the PCP, Hospitalists, and other providers to assist with the coordination of benefits of our members. Coordinates and discuss alternative care requests from the attending physicians' offices/panelists, appropriate hospital staff (i.e., discharge planner, social worker, utilization review nurse, ancillary providers, or AvMed Utilization Review staff. The ICM will coordinate the care and services of selected Member populations across the continuum care; promotes effective utilization and coordinates health care resources. The ICM will be responsible for working with the physician, AvMed Pre-Authorization, Disease Management or other Case Management programs, Concurrent Review staff, and the Member and/or family to promote quality care that is delivered in the most appropriate setting. The ICM will work with the Medical Director, UM Manager, Supervisor to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the benefit for the Member. The overall impact of the role of the ICM is to promote continuity of care, to assist the Member in overcoming any barriers to care and to promote Member satisfaction. Performs concurrent utilization review on all assigned hospitalized Members, using clinical guidelines and reports clinical information to Medical Director, UM Manager, Supervisor. Works with members continuum of care utilizing Welcome Home Calls and continue Home Health Care after discharge for those not enrolled in Complex Case Coordination.

Education/Experience Requirements:

Registered Nurse with current Florida license. Five (5) years acute care experience. Managed care experience. Home health, Rehabilitation, and/or discharge planning experience. Ability to work independently with minimal supervision. Able to work closely with other team members.

AvMed Health Plans is a Drug/Tobacco-Free Workplace, EOE.