Job Description

Care Manager RN

Business Office · Care Management
Plantation, FL
Health Care
Full Time, Days
Weekly Schedule: Monday - Friday8:00am - 5:00pm
Bilingual: None
Bilingual Type: N/A
Posted 05/02/2019
Req # 3073
    • As a Care Manager, you will assist in the development, implementation, and operations of a comprehensive Care Management program in order to distinguish Pediatric Associates in the market on the basis of demonstrating health care quality, efficiency and interconnectivity for patient care management and coordination in support of the mission, core values, goals and objectives of Pediatric Associates.
    • This list may not include all of the duties that may be assigned.
    • Implements and monitors the case management program focused on population health management.
    • Develops and maintains an integrated clinical care management model that fosters appropriate levels of care and maximized reimbursement / cost savings.
    • Administers care management partnerships with commercial payers and other entities.
    • Establish innovative relationships with payers and employers that promote value and expand market share.
    • Serves as liaison between across the revenue cycle management departments to coordinate effective information flow related to payer contracts and reimbursement.
    • Informs patients regarding general preventative care practices as well as individualized care plans.
    • May keep track of and/or update patients' records, especially electronic records, and must keep current with computer technology, software, security measures, and legislation regarding patient privacy and other issues.
    • Monitors changes in a patient’s status and subsequent alterations to the care plan.
    • Helps implement measures to improve patient care.  Reviews utilization practices and facilitates positive changes to patient behaviors regarding their medical care.
    • Education:
      • A Bachelor’s degree in nursing or related field or combination of education and experience in care management, practice administration and/or managed care. Registered Nurse (RN) designation / license. Care management experience in managed care industry, physician group practice or health care required. Significant knowledge of care management, population health management and operational issues related to payers and networks, physician groups, and health insurance benefit plan designs.

    • Licensure:

    • Knowledge, Skills & Abilities:
      • Must have patient management skills.
      • Knowledge of medical billing and health records maintenance.
      • Knowledge of ICD-10, ICD-9, CPT and HCPCS coding.
      • Must have excellent interpersonal and communication skills.
      • Must have excellent decision making and problem solving skills.
      • Must be detail oriented and have good analytical skills.
      • Knowledge of laws governing the protection of patients’ private health information.
      • Substantial experience in managed care business development/financial management/consulting with an emphasis on population health and value based contracting.
      • Excellent clinical skills, operations and systems administration / analysis.
      • Demonstrated experience working effectively with payers, employers, state government, and other external influencers
      • Extensive knowledge of health care delivery, including business planning, operations and finances, coupled with an ability to effectively respond to elements to drive competitive advantages
      • Knowledge of emerging public health issues, health care inequities, health care financing, and health systems

    • Experience:

    • Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
COMPANY OVERVIEW: Founded in 1955, Pediatric Associates is one of the oldest and most respected pediatric practices in the United States. Pediatric Associates opened its first office in Hollywood, Florida. The Company was one of the first medical groups to introduce satellite office locations in consumer retail locations. They were also one of the first pediatric groups to embrace managed care in the 1970s, collaborating with insurance plans as healthcare partners with the common interest of providing South Florida's children with the best healthcare available. Today, Pediatric Associates is a national leader in pediatric population health management with over 200,000 patients under global risk. Keeping abreast of medical advances and changing lifestyles, Pediatric Associate’s modern facilities offer comprehensive services, including X-ray and state certified laboratories. The Company currently has 33 neighborhood locations, which are staffed by more than 200 employed providers who proudly serve families throughout Miami-Dade, Broward, Palm Beach, St. Lucie, counties, including Tampa and Jacksonville. Pediatric Associates will continue to bring the best possible healthcare service to its patients well into the 21st Century. Ease of access, prompt courteous service and responsiveness to our patients' concerns will always be their primary goal. Pediatric Associates has continued to thrive and today is recognized as one of the premier general pediatric and population health management practices in the United States.

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