Care Manager - (LPN/ RN) Winter Park, FL

OVERVIEW OF POSITION:

The Care Manager reports to the Center Administrator and is responsible for the oversight of pre-certification, patient care management, discharge planning, and health plan compliance within the center.

ESSENTIAL FUNCTIONS:

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer.
• Represents the Company in a professional manner, following all Company policies and procedures.
• Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Monitors inpatient, outpatient, and SNF patients and initiate patient care arrangements.  Reports findings to Medical Management, Medical Director and Center Administrator.
• Responsible for patient care management to assure appropriate care is provided; reinforce patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinate home health and DME requests and provide recommendations to the Center Medical Director. 
• Provides oversight in patient care evaluation, coordinate the collaboration of the Primary Care Provider and Consultants, and make suggestions to improve plans to meet patient needs. 
• Assists with the monitoring of utilization management and make recommendations regarding effectiveness of health care resources, trending and intervention. 
• Assists in the assessment of clinic operations and make recommendations as necessary. 
• Ensures compliance with HCFA guidelines and covered service guidelines. 
• Assists with the contestation of Part A and Part B /claims as needed. 
• Consistently applies guidelines to the medical record review process. 
• Evaluates and recommends health delivery network changes with the site Medical Director and Center Administrator. 
• Participates in QI projects.  Attends Care Management Meetings. 
• Participates in patient satisfaction programs as required and follows up on all inpatient/outpatient discharges. 
• Assists the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans.
• Performs additional duties as assigned.
• Must have consistent, punctual and reliable attendance.
• Ability to travel may be required.

EDUCATION:

• High school graduate, GED or equivalent.
• Must possess a current and valid LPN or RN Florida state license.
• LPNs:  IV Certification preferred.  
• RNs: Associates or Bachelor’s degree in Science required.  

EXPERIENCE:

• 3 to 5 years of recent clinical nursing experience.
• 1-2 years of previous care management, utilization review or discharge planning experience is preferred.
• Managed care experience preferred.

KNOWLEDGE, SKILLS, ABILITIES:

• Ability to provide on-site clinical treatment within scope of practice.
• Ability to perform accurate telephonic triages, accurately record findings with follow-up.
• Knowledge and skill in the applications of the techniques and practices of the nursing profession.
• Ability to explain medical instructions to patients and their families.
• Ability to learn and understand appropriate Federal, State, and local regulations.
• Ability to communicate effectively with patients and all levels of personnel/customers in a professional, courteous and effective manner using excellent customer service skills.
• Ability to be a clinical resource for non-licensed office staff.
• Ability to prioritize and multi- task in a high paced environment with good organizational skills.
• Display initiative, accountability and resourcefulness.
• Ability to perform care management.
• Must be computer literate.
• Knowledge of HIPAA regulations.
• Ability to read, speak, write, and understand the English language fluently. 

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington. A leading medical group in America, DaVita Medical Group has over two decades of experience providing coordinated, outcomes-based medical care in a cost-effective manner. As of December 31, 2016, DaVita Medical Group’s 2,000 employed clinicians, 12,000 teammates, and network of 13,000 affiliated clinicians provided care for approximately 1.7 million patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

DaVita Medical Group is an equal opportunity/affirmative action employer.  As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status. 

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.