[Hiring] OPS MEDICAL CASE MANAGER @State of Florida

Role Description

This is a professional position responsible for medical case management and consultation throughout the Region. The incumbent works in an interdisciplinary fashion within the construct of the regional structure. Primary duties include, but are not limited to:

• Clinical oversight of medical case reviews
• Medication administration training and monitoring
• ICF/IID admissions
• Eligibility reviews
• Other health-related quality controls which will require some travel to community locations

Works collaboratively with state office nursing/clinical team regarding the health and safety of Agency clients.

Responsibilities include:

• Serves as medical case manager to provide training for the provision of services outlined in the Medication Administration Rule FAC 65G-7, and monitors compliance
• Coordination of approved Medication Administration trainers
• Monitoring compliance in licensed group/foster homes
• Providing technical assistance to waiver support coordinators, supported living coaches, Adult Day Training (ADT), providers, and regional office staff
• Attending local Children’s Medical Assessment Team (CMAT) meetings
• Coordinating consumer health-related service requests
• Completing medical case management reports, Special Medical Home Care recommendations, Significant Additional Needs requests, Skilled Nursing Exception Letters, medical review, and Incident Management System reporting for illness, injury, or accident
• Performing all ICF/IID facility admissions review to determine level of reimbursement
• Completing Facility Notification Regarding Day One Letter
• Providing annual choice counseling for consumers residing in ICFs
• Completing medical reviews for consumers transitioning out of the DDCs that require medical follow-up, at 14 days and 90 days after transition
• Completing all reports of death per requirement, and mortality reports upon request
• Conducting SAO’s annual monitoring and data reporting as appropriate
• Participating in Agency Hearings, meetings, and client staffing
• Providing consultation for Medicaid exception denial requests and eligibility reviews as needed
• Performing additional duties as required

Qualifications

• Bachelor of Science in Nursing is preferred
• Must have a valid Driver’s License or other efficient means of transportation to travel for work purposes and willing to travel
• Minimum 2 years of Registered Nursing experience

Requirements

• Knowledge of individuals with development/intellectual disabilities preferred
• Knowledge of case management and medical record reviews
• Ability to create and maintain Excel Spreadsheets
• Demonstrate skills in Microsoft Office, including Outlook, PowerPoint, and Teams
• Effective written and verbal communication skills

Benefits

• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options
• Retirement plan options
• For a more complete list of benefits, visit www.mybenefits.myflorida.com