POSITION TITLE: Complex Case Manager
JOB NUMBER: 700-020
DEPARTMENT: Utilization Management
GENERAL PURPOSE: The Complex Case Manager coordinates the care and service of selected member populations across the continuum of illness; promotes effective utilization and monitors health care resources; and, assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the Manager, Case/Disease Management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Evaluates the member’s need for alternative services, assesses short-term and long-term needs, establishes case management objectives and executes plan to achieve objectives.
- Manages active cases based on case intensity and acuity.
- Demonstrates effective communication methods and skills, using lines of authority appropriately.
- Regular & prompt attendance is required as employee works as part of a team & requires frequent interaction with medical staff and members.
- Establishes a relationship with member, family, physician(s), and other providers to determine medical history and current status and to assess the options for care and use of benefits and community resources.
- Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
- Maintains accurate record of case management activities.
- Adheres to quality standards and all case management and confidentiality policies and procedures.
- Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
- Adapts to changes in policies, procedures, new techniques and additional responsibilities.
- Performs other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: Florida licensed RN or LPN required; CCM preferred; an undergraduate degree from an accredited institution of higher learning preferred; minimum five years related experience required; managed care experience preferred; or an equivalent combination of education, training and experience.
NECESSARY KNOWLEDGE, SKILLS AND ABILITIES: Ability to: work from designated office for collaborative/interactive fulfillment of duties; concentrate in an open-office “cubicle” environment; appropriately and directly interact with other staff members and/or outside associates; perform telephone and/or computer work for extended periods of time; operate office equipment such as computer, telephone, and copy/scan/fax machine; attend and participate in meetings via phone, computer, or in person.
- Ability to read and interpret documents and calculate figures and amounts.
- Excellent oral and written communication skills with good grammar, voice and diction with all educational levels or membership.
- Intermediate proficiency in MS Office with emphasis on Word and Excel programs with intermediate level computer and keyboarding skills.
- Excellent customer service skills (friendly, courteous and helpful).
LICENSING AND CERTIFICATION: Florida licensed RN or LPN required.
PHYSICAL DEMANDS: The physical demands described here are representative of those that should 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.
While performing the duties of this job, the employee is regularly required to sit.
The employee frequently is required to manipulate or use objects, equipment, tools, and/or controls.
May require specific vision abilities to perform this job.
Ability to lift, carry or exert items or objects of reasonable weight.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Attendance at employer worksite is an essential job requirement.
The noise level in the work environment is usually moderate.
For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office environment.
ADDITIONAL INFORMATION: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.