Orlando Health
Position Summary
Orlando Health Winnie Palmer Hospital for Women & Babies
Located on the downtown Orlando campus, Orlando Health Winnie Palmer Hospital for Women & Babies opened in 2006, providing programs and services focused on the unique needs of women and newborns. Specialized care covers all facets of women's health, from comprehensive gynecological services and minimally invasive surgeries to obstetrics and high-risk pregnancies and births. The hospital is "Magnet" recognized for nursing excellence and high-quality patient care and is certified in perinatal care by The Joint Commission. Welcoming nearly 14,000 babies each year, the hospital's 350 beds include 142 neonatal intensive care beds, making it one of the largest neonatal intensive care units under one roof in the country. As a sister hospital with Orlando Health Arnold Palmer for Children, the hospital was included in the 2021-22 "Best Children's Hospitals" rankings by U.S. News & World Report, recognized for expertise in Neonatology, and, together with Orlando Health ORMC, was included in the IBM Watson Health 100 Top Hospitals® list for 2021.
Winnie Palmer Hospital for Women and Babies Care Management is seeking
Director for Care Management.
The Director of Care management leads the care management team in facilitating appropriate use of hospital resources and effective discharge planning and coordination of services to transition patients to the next appropriate level of care
Responsibilities
Essential Functions • Manages educational, financial and human resources for the care management teams to deliver high quality, cost effective, and responsive patient-focused health care services. • Coordinates the workload distribution and scheduling of the care management team members to assure adequate and appropriate staffing to meet the needs of patients and families within the Orlando Health network. • Develops collaborative relationships with the site leadership, medicalstaff leadership, managed care contractors, and community leaders. • Supports positive relationships with payors and develops plansto optimize reimbursement and quality of care. • Monitors working DRGs and GMLOS assignment as appropriate. • Implementsthe performance improvement processto include outcome measurement asitrelatesto the identification of processes/ strategies/ opportunities that promote population health. • Achievesresults by developing strategiesto manage patient care acrossthe continuum, focusing on high risk, high cost and problem prone areas to include patient at risk for re-admission. • Supports processes for clinical quality/ cost-improvement initiatives/ preventing re-hospitalizations. • Develops recommendations to expand the integration of post-acute care services and hospital operations to better meet the needs of Orlando Health and the community. • Designs educational strategies to assure compliance with regulatory standards for NCQA, HIPAA, CMS, and other local, state and federal organizations as applicable. • Coordinates budget implementation with regard to payroll,supplies and miscellaneous otherfunctionsthat deal with the financial performance of the departments overseen, • Serves as a department intermediary forservice problems. • Ensuresincident reports are completed appropriately and follows up with incidentreports as needed. • Organizes/leadsstaff meetings and huddles. • Embraces, promotes and communicates change. • Demonstrates professional accountability by maintaining proficiency in assigned role and involvement in professional organizations and continuing education. • Holdsself and others accountable to Orlando Health's mission, vision and values. • Develops and recommends concepts relative to new business opportunities, subsidiary organizations, acquisitions, current business design or other organization structuring to optimize organizationalstrength and meet operating mission. • Manages various human resources functions including hiring, work assignments, coaching plans, and performance counseling. • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards. • Maintains compliance with all Orlando Health policies and procedures.
Other Related Functions • Knowledge of hospital and department policies and procedures as well as knowledge ofregulatory requirementsrelevant to the care management department. • Ability to compile, analyze and interpret data to include the advanced application in spreadsheet generation and the use of graphics, database management and word processing software. • Serves as facilitator to physicians and nursing staff on utilization and discharge planning, care coordination, and utilization management issues. • Demonstratesthe knowledge of labor and expense budgets, as well asrevenue and census projections/ development. • Maintains confidentiality of data and information.
Qualifications
Education/Training
Graduate of an approved school of nursing program (BSN). Graduate of an approved school of nursing, Master's in Social Work (MSW), Mental Health Counseling (MHC), or Marriage and Family Therapy (MFT).
Licensure/Certification • Florida RN license required and maintained current if graduated from an approved school of nursing. and BLS/Healthcare Provider certification required. • BLS/Healthcare Provider Certification within 90 days of hire.
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Preferred to include at least two (2) years in utilization management.
Orlando Health Winnie Palmer Hospital for Women & Babies
Located on the downtown Orlando campus, Orlando Health Winnie Palmer Hospital for Women & Babies opened in 2006, providing programs and services focused on the unique needs of women and newborns. Specialized care covers all facets of women's health, from comprehensive gynecological services and minimally invasive surgeries to obstetrics and high-risk pregnancies and births. The hospital is "Magnet" recognized for nursing excellence and high-quality patient care and is certified in perinatal care by The Joint Commission. Welcoming nearly 14,000 babies each year, the hospital's 350 beds include 142 neonatal intensive care beds, making it one of the largest neonatal intensive care units under one roof in the country. As a sister hospital with Orlando Health Arnold Palmer for Children, the hospital was included in the 2021-22 "Best Children's Hospitals" rankings by U.S. News & World Report, recognized for expertise in Neonatology, and, together with Orlando Health ORMC, was included in the IBM Watson Health 100 Top Hospitals® list for 2021.
Winnie Palmer Hospital for Women and Babies Care Management is seeking
Director for Care Management.
The Director of Care management leads the care management team in facilitating appropriate use of hospital resources and effective discharge planning and coordination of services to transition patients to the next appropriate level of care
Responsibilities
Essential Functions • Manages educational, financial and human resources for the care management teams to deliver high quality, cost effective, and responsive patient-focused health care services. • Coordinates the workload distribution and scheduling of the care management team members to assure adequate and appropriate staffing to meet the needs of patients and families within the Orlando Health network. • Develops collaborative relationships with the site leadership, medicalstaff leadership, managed care contractors, and community leaders. • Supports positive relationships with payors and develops plansto optimize reimbursement and quality of care. • Monitors working DRGs and GMLOS assignment as appropriate. • Implementsthe performance improvement processto include outcome measurement asitrelatesto the identification of processes/ strategies/ opportunities that promote population health. • Achievesresults by developing strategiesto manage patient care acrossthe continuum, focusing on high risk, high cost and problem prone areas to include patient at risk for re-admission. • Supports processes for clinical quality/ cost-improvement initiatives/ preventing re-hospitalizations. • Develops recommendations to expand the integration of post-acute care services and hospital operations to better meet the needs of Orlando Health and the community. • Designs educational strategies to assure compliance with regulatory standards for NCQA, HIPAA, CMS, and other local, state and federal organizations as applicable. • Coordinates budget implementation with regard to payroll,supplies and miscellaneous otherfunctionsthat deal with the financial performance of the departments overseen, • Serves as a department intermediary forservice problems. • Ensuresincident reports are completed appropriately and follows up with incidentreports as needed. • Organizes/leadsstaff meetings and huddles. • Embraces, promotes and communicates change. • Demonstrates professional accountability by maintaining proficiency in assigned role and involvement in professional organizations and continuing education. • Holdsself and others accountable to Orlando Health's mission, vision and values. • Develops and recommends concepts relative to new business opportunities, subsidiary organizations, acquisitions, current business design or other organization structuring to optimize organizationalstrength and meet operating mission. • Manages various human resources functions including hiring, work assignments, coaching plans, and performance counseling. • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards. • Maintains compliance with all Orlando Health policies and procedures.
Other Related Functions • Knowledge of hospital and department policies and procedures as well as knowledge ofregulatory requirementsrelevant to the care management department. • Ability to compile, analyze and interpret data to include the advanced application in spreadsheet generation and the use of graphics, database management and word processing software. • Serves as facilitator to physicians and nursing staff on utilization and discharge planning, care coordination, and utilization management issues. • Demonstratesthe knowledge of labor and expense budgets, as well asrevenue and census projections/ development. • Maintains confidentiality of data and information.
Qualifications
Education/Training
Graduate of an approved school of nursing program (BSN). Graduate of an approved school of nursing, Master's in Social Work (MSW), Mental Health Counseling (MHC), or Marriage and Family Therapy (MFT).
Licensure/Certification • Florida RN license required and maintained current if graduated from an approved school of nursing. and BLS/Healthcare Provider certification required. • BLS/Healthcare Provider Certification within 90 days of hire.
Experience
Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Preferred to include at least two (2) years in utilization management.