Synergy Healthcare Services
  • Synergy Healthcare Services - Remote
  • Maitland, FL, USA
  • Full Time

Looking for qualified Case Manager to join our team!

We are searching for a Case Manager to join our community that is resident and family focused, a team builder, and excited about the opportunity to assist in building a culture.

If you are a Case Manager that has business acumen, is team-oriented, driven, and excited about the opportunity to build a culture, then we have the perfect opportunity for you!


Perks and Benefits

  • Pay rate: Competitive salary, along with holiday pay and unlimited Work Life Balance (WLB) program.
  • Innovative Purchasing Program: We offer a purchasing program that allows you to buy thousands of products (technology, furniture, clothing, etc.) and pay over time. Zero interest, no credit check, no hidden fees.
  • Access to online learning 24/7: Our Learning Management System offers over 1,500 courses for senior care, health and human services industry. Use it for free to help satisfy your state specific licensure requirements. Data base includes, MS Office and Leadership/Supervisory content. Available via computer or mobile, and many courses are offered in alternative languages.
  • Phone and auto discounts: Up to 20% on employee personal wireless accounts and auto rentals through designated vendors.
  • Employee Assistance Fund: You are always there for others. Let us be there for you. In unexpected catastrophic situations you can confidentially apply for help.

Major Responsibilities

  • Responsible for the identification, development, implementation, and evaluation of best practice initiatives designed to improve the health, access to care and reduce cost for the population served.
  • Provides clinical leadership for the Managed Care, Bundle Payment and ACO programs by serving as an educator, role model, member advocate, to enhance patient care and staff competency.
  • The Case Manager collaborates with other departments (including Clinical Staff, Administration, Directors, Managers, and others), to evaluate, coordinate and direct activities and programs in support of delivery of patient care.
  • Management and Assessment of Quality/Efficiency Indicators.
  • Oversee the data collection process as needed by Payors, ACOs and bundled payments.
  • Review the information and identify and highlight successes and identify and take action on areas needing improvement.
  • Serve as the lead for review of Payor, ACO, bundled payment quality/efficiency reports and work with the Care Center's teams as needed to improve scores.
  • Will be responsible for improving the Quality/Efficiency scores as deemed necessary to align with payor's, ACO's, and bundled providers requirements for participation.
  • Assess adequacy of discharge plan and addresses any risk associated with discharge with internal associates and external case managers, PCP's and others designated to care for the patient.
  • Develop care plan and interventions with patient and family input, physician, clinical team and referral source as appropriate.
  • Proactive post discharge follow-up; telephonically for a minimum of 30 days following discharge.
  • Identification of metrics to measure performance of health outcomes, efficient utilization and access to care and overall cost.
  • Develop, implement and maintain systems, policies and procedures for the collection and analysis of performance metrics
  • Collaborates effectively with the patient's health care team to establish an optimal cost effective plan while inpatient and transitioning to the next level. The health care team may include physicians, health plan UM/CM Nurse, hospital discharge planners, referral coordinators, etc.
  • Consults with the Physician and health plan to resolve any barriers in the patient's movement along the continuum of care.
  • Provide innovative, responsible healthcare with the creation and implementation of new ideas and concepts that continually improve systems and processes to achieve superior results as well as the development of a successful management team.

Minimum Qualification

  • Must possess a Degree in Nursing.
  • Must have, as a minimum, two (2) years' experience in a hospital, nursing care facility, or other related health care facility.
  • Must have a working knowledge of managed care rules, regulations, and guidelines.
  • Must have comprehensive knowledge of managed care, health insurance, and Case Management.
  • Ability to negotiate coverage and provide complete and timely case management, bundled payment and ACO reports.
  • Prior experience with a Health Plan, private or third party case management company preferred.
  • You must be qualified, compassionate, and dedicated to a job well done.

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

Synergy Healthcare Services
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