Utilize clinical expertise and critical thinking skills to develop and implement a plan of care for residents, coordinating with families, providers, insurers, and community resources to deliver high-quality, cost-effective care.
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Responsibilities
Communicate regularly with residents and their families about Plans of Care, PT, OT and other treatment protocols.
Attend and participate in morning meetings/stand up to facilitate communications with the team.
Answer residents’ questions about their care, treatment plans, illness progression and all other issues so they feel safe and secure in our care.
Monitor and adjust residents’ statuses based on changing needs and conditions.
Organize and prioritize daily work by assessing new, current and discharging residents' needs in the area(s) of responsibility.
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Compensation
Pay Range: $56,200.00 - $101,000.00 per year
Responsibilities
Develops, assesses, and facilitates complex care management activities for primarily physical needs members
Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Provides resource support to members and care managers for local resources for various services based on service assessment and plans
Facilitates care management and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
Coordinate insurance verification and authorization processes for surgical patients at St. Francis Surgery Center.
Responsibilities
Verify patient insurance eligibility, benefits, deductibles, copayments, coinsurance, and out-of-pocket responsibilities prior to scheduled procedures.
Obtain required prior authorizations, referrals, and pre-certifications to ensure procedures are approved before the date of service.
Communicate effectively with insurance companies, physician offices, and patients to resolve coverage issues and insurance discrepancies.
Educate patients regarding estimated financial responsibility, including copays, deductibles, and non-covered services.
Collaborate with scheduling, clinical, business office, and physician office staff to ensure all insurance requirements are met and procedures proceed as scheduled.
The HIM Manager of Coding Compliance and Denials Management performs advanced level work related to clinical and DRG denial management. The individual is responsible for managing denials related to referral, authorizations, notifications, non-coverage, medical necessity, DRGs and others as assigned.
Responsibilities
Perform advanced level work related to clinical and DRG denial management
Conduct comprehensive reviews of medical necessity denial and DRG Denial
Review medical records to determine if a revised claim needs to be submitted, if a retro authorization needs to be obtained, or if a written appeal is needed
Write and submit professionally written appeals including compelling arguments based on clinical documentation, third-party payer medical policies, and contract language
Handle audit-related/compliance responsibilities and administrative duties
The Regional Director of Operations leads the operational management of all centers within an assigned region, overseeing quality of care, financial performance, and team member culture.
Responsibilities
Directly supervises, coaches, and develops Center Directors to strengthen center leadership and build a high-performing engaged workforce.
Sets clear goals, provides regular feedback, evaluates performance, and holds leaders fairly and consistently accountable for results, quality, and conduct.
Models and reinforces a culture aligned with PACE SEMI’s mission, values, and Ten Principles.
Partners with Human Resources and Organizational Development (HR/OD) on leadership development and succession planning.
Promotes diversity, equity, and inclusion across the organization.
Requirements
Bachelor’s degree in healthcare administration, business, nursing, or a related field
Responsible for the coordination and completion of assessments for each patient including the Resident Assessment Instrument (RAI) and CAAs, ensuring compliance with CMS requirements within the LPN Scope of Practice.
Responsibilities
Communicates between nursing center departments and patient/family members to gather information for an effective completion of the MDS
Maintains open lines of communication with consultants, supervisors, and interdisciplinary team
Conducts/coordinates patient (or family) interviews in compliance with RAI process guidelines
Evaluates each patient’s condition and medical data to determine special needs
Participates in scheduling of assessment/care plan meetings and coordination of schedule with nursing center staff and others
An advanced-level specialist responsible for conducting and reviewing eligibility determinations across TANF, SNAP, and Medicaid programs, serving as a key program resource to fellow employees by providing policy guidance and technical support.
Responsibilities
Conduct initial and ongoing eligibility determinations for TANF, SNAP, and Medicaid, including highly complex cases requiring advanced program knowledge.
Serve as a program resource to fellow employees, providing guidance, answering policy questions, and helping staff navigate detailed public assistance regulations.
Monitor program trends, prepare seasonal and annual reports, and participate in quality improvement projects.
Engage in outreach, task forces, strategic planning, mentoring, and training activities to support agency goals.
Manage a caseload involving complex household circumstances, fluctuating income, multi-ownership situations, and evolving client needs.
Requirements
High school diploma supplemented with additional training and related work experience OR any equivalent combination of training and experience
Provides in-home, office and telehealth outpatient mental health assessment and counseling services, and provider education and consultation for children 0-8 and their families in Duval County.
Responsibilities
Provide in-home, in person, office or telehealth screenings, assessment and therapy to children (ages 0-8), adults and families.
Provide supportive case management to families on caseload to ensure the safety of children in the home and improve family well-being.
Maintain in home visitation with child, parent and siblings, including minimum of one-hour weekly home visits/team meetings.
Complete assessments on children and families, providing recommendations for treatment and support for child and family members.
Works with all staff involved to ensure services support of the family's case plan.
Requirements
Masters’ Degree in Social Work or Mental Health Counseling or related field
Nice to have: experience with the high-risk newborn and child population
Nice to have: Training in Infant Mental Health
Nice to have: Trauma Focused Cognitive Behavioral Therapy
The role involves coordinating insurance and financial assistance options for kidney dialysis patients, maximizing revenue, and adhering to compliance programs.
Responsibilities
Meets regularly with dialysis patients at the clinic(s) in the assigned region to educate and coordinate insurance options
Educates on the availability of alternative insurance options (i.e., Medicare, Medicaid, Medicare Supplement, State Renal programs and COBRA)
Ensures patients have followed through with the application process
Obtains premium statements and signatures from patients
Discusses situation and options if employment status changes or other situations change
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