InnovaCare Health

With nearly 40 clinics across Florida and Texas, InnovaCare Health is a dynamic physician-led healthcare organization innovating change in value-based healthcare. We are recognized for transforming care delivery. To empower providers to succeed in some of the most challenging environments in healthcare, we combine physician-led care models with cutting-edge technology and a focus on personalized, coordinated care. 

Our work at InnovaCare is always part of a bigger mission. Each member of our team is expected to serve their community through their hard work and dedication.  Training and support are provided to our employees so that they can grow professionally and better serve their communities. With health insurance, 401Ks, and paid time off, you'll get the best benefits in the industry.

Our professional team keeps our clinics running. As we grow, we invite you to explore opportunities with InnovaCare Health. To fulfill our mission and provide our patients with a first-class experience, we're seeking hard-working, career-minded individuals. Our mission is to improve the lives of our patients every day.

JOB SUMMARY:

The Case Manager plays a critical role in ensuring smooth transitions of care for patients as they move between different healthcare settings. This position requires a compassionate and organized individual who can effectively coordinate care plans, facilitate communication among healthcare providers, and advocate for the needs of patients during transitions. The Case Manager works closely with patients, families, healthcare teams, and community resources to optimize continuity of care and improve patient outcomes. 

This position will lead the development and execution of discharge care plans and post-acute stabilization for their assigned facilities and/or region. As part of this work, this role will build strong relationships with facilities and their leadership to promote coordination of care and improve health outcomes and patient experience.  

This role requires strong interpersonal skills, clinical expertise, and a deep commitment to patient-centered care. The Case Manager collaborates with multidisciplinary teams to assess patients' needs, develop comprehensive care plans, coordinate services, and advocate for patients' well-being during transitions. By providing education, support, and advocacy, the Case Manager helps empower patients and families to navigate the complexities of the healthcare system and achieve optimal outcomes. 

ESSENTIAL JOB FUNCTIONS:

Coordinate care transitions for patients across healthcare settings, including hospitals, rehabilitation facilities, skilled nursing facilities, and home care 

Conduct comprehensive assessments of patients' medical, social, and psychosocial needs to develop individualized care plans that promote continuity of care and support successful transitions. 

Facilitate communication among healthcare providers, patients, families, and caregivers to ensure alignment of care goals, preferences, and plans during transitions. 

Advocate for patients' needs and preferences during transitions of care, ensuring that their voices are heard and their concerns are addressed. 

Provide education, resources, and support to patients and families to promote understanding of the care transition process, medication management, self-care strategies, and available community resources. 

Identify and address potential barriers to successful care transitions, such as medication errors, gaps in communication, and inadequate follow-up care. 

Participate in quality improvement initiatives aimed at enhancing the effectiveness, efficiency, and safety of care transitions. 

Maintain accurate and thorough documentation of care transitions, assessments, interventions, and outcomes in accordance with regulatory requirements and organizational policies. 

Ensures compliance with Federal and State regulatory agencies and demonstrate current knowledge of industry trends and changes related to Medicare Advantage and ACO 

Travels to the InnovaCare Partner practices from time to time.  

MINIMUM REQUIRED EDUCATION, EXPERIENCE & SKILLS: 

Bachelor's degree in nursing, social work, or a related field 

Relevant active and unrestricted clinical licensure (MD, DO, ARNP, RN, etc.) 

Minimum of 3 years of clinical experience in healthcare, with a focus on care coordination, case management, or transitional care. 

Strong knowledge of care management  

Strong knowledge of hospital-based care and transitional care management  

Experience working with diverse patient populations, including those with complex medical, social, and psychosocial needs. 

Strong knowledge of Medicare Advantage and Dual Special Needs 

Strong leadership and communication skills and the ability to create working relationships with key stakeholders internally and externally.  

Ability to work collaboratively in a team-based environment. 

Proficiency in electronic health record systems and documentation practices. 

Excellent communication, interpersonal, and organizational skills. 

Ability to manage multiple priorities and deliver results in a fast-paced environment.  

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.