Utilization/Quality Assurance Manager Job in Jacksonville 32210, Florida Us

Aging True, formerly Urban Jacksonville, Inc., an affiliate of The Cathedral Foundation, is a not-for-profit organization located in Jacksonville, Florida.  We provide a wide variety of important services to seniors and disabled adults in our community.  Urban Jacksonville is looking for the right person to join our team as a Utilization Manager. 

 

The Utilization Manager will act as a liaison for programs of Aging True in conjunction with the case manager in dealing with individual and institutional providers and with clients to maximize the quality of care and cost-effective utilization of services.  Up to half of the UM’s time may be spent in field work at hospitals, skilled nursing facilities and rehabilitation facilities coordinating discharge plans with the facility and client. 

 

Compensation for this full-time position includes health, life insurance, participation in a retirement plan, up to 31 paid days off per year, and a tuition reimbursement program.  Salary is dependent upon experience and education.

 

Qualifications/Requirements include:

·         A registered nurse licensed to practice in the state of Florida.

·         Experience working with the senior population

·         Prior supervisory and initialization review experience preferred.

·         Must have a valid driver’s license, automobile insurance and submit to a level II background and drug screening.

 

General responsibilities of the Utilization Manager include:

·         Conduct clinical review of all applicants’ referral packets from CARES to Urban Jacksonville’s Senior Connections Nursing Home Diversion Program to determine the medical necessity to schedule an RN visit for care plan recommendations.

·         Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in member’s records.

·         Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services.

·         Monitors and tracks in-patient/skilled rehab Length of Stay and continued-stay days for members in hospitals and skilled rehab facilities.

·         Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of medical facility admissions for clients of Urban Jacksonville.

·         Identifies cases for potential risks/complications.

·         Performs concurrent and retrospective clinical chart reviews to ensure maximization and cost effective utilization of services.

·         Refers to the Medical Director on all cases that do not meet established guidelines for continued short term stay or long-term admission using Milliman guidelines as a resource tool.

·         Recommend the modification of client's care plan based on medical records reviews and other information as needed.

·         Coordinates and supervises the activities of the Utilization Review Committee.

·         Chairs the Utilization Review Committee meetings.

·         Other duties as assigned by the supervisor

 

Working Conditions/Physical Requirements:

·         Business hours are Monday through Friday, 8:30 a.m.-5:00 p.m.

·         Due to circumstances that may arise, overtime maybe required at times.  In all cases, overtime must be pre-approved by your supervisor.

·         The person in this position frequently communicates with vendors who have inquiries or questions.  Must be able to exchange accurate information in these situations.

·         Must be willing to use personal vehicle for travel during the day.

·         Frequently in Skilled Nursing Facilities, Assisted Living Facilities and member home settings.