Supervisor, Case Management: AvMed Health Plans

Supervise the Complex Management staff by handling the day-to-day operations for the following functions: Member initiatives including, continuity of care, elimination of perceived/actual barriers, impact quality of Member’s health, effective use of healthcare resources and promotion of member satisfaction. Collaboration with Health Care Providers to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of Care Management Members. The coordination of internal departments to support maximization of benefit administration.

Supervises the review and acceptance process for Members identified by referral or otherwise that are considered at risk for adverse outcomes and/or health care condition would benefit from the Care Management Program. Track and monitor care management referral sources and routinely report findings to Manager. Maintain up-to-date information/reference material related to Member and Provider Contract language and act as the Department’s resource for this information. Supervises the work product produced by all care management staff to assure consistency with care management workflows/protocol. Executes a process that supports the ability to routinely validate the accuracy of documentation supplied by the Care Management Staff consistent with workflow(s)/protocol(s), including but limited to the plan of care, PCP/Specialist/Members contacts, authorization and creation of MOR flag in all designed business applications. Serve as the departmental Super-User for the AMISYS, Casetrakker, and MACESS applications. Actively assist the manager with the formulation and communication of employee disciplinary action. Assist the Manager in developing job descriptions, procedures, and workflows. Consistently assesses and prioritizes Care Management Staff’s workload to realize care management objectives.

Education/Experience Requirements:

Registered Nurse with current Florida license. Five (5) years acute care experience. Managed care, home health, walk-in clinics, occupational health nursing, and/or discharge planning experience. Minimum of 3 years of case management experience. Complex Case Management certification required.

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