Assistant Manager - Greater Miami Youth For Christ - Miami

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• USAA

  

  SIU Major Case Manager (Medical Provider)

  hace 2 días

  Miami

  Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated SIU Major Case Manager (Medical Provider), you will be responsible for operational management of Claims fraud investigative teams. Directs staff in the investigation of cases involving questionable, suspect, or fraudulent activity. Ensures compliance with policies and procedures contributing to fraud control objectives, as well as compliance with state insurance fraud-related laws and regulations. This role is remote eligible in the continental U.S. with occasional business travel. What you'll do: Responsible for insurance fraud detection and investigation services to reduce fraud-related claim payments and costs, while avoiding unwarranted risk. Ensure compliance with laws and regulations relating to claims handling and unfair claims practices and reporting statutes. Participates in the establishment and implementation of policies and procedures for fraud control and investigative practices. Performs leadership and management tasks, i.e., providing coaching, evaluating performance, review of time sheets, managing time off, conducting quarterly check-ins/ride-alongs, etc. Evaluates, authorizes, and implements actions and decisions to carry out proactive claim's projects and investigations. Review and evaluate investigation recommendations from investigators to ensure results and case documentation support conclusions. Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: Bachelor's degree; OR 4 years of relevant education and/or experience. 2 years of demonstrated leadership experience, supervisory or management experience in major case medical provider. 6 years’ experience in medical provider fraud and P&C industry functional work OR 4 years of medical provider P&C experience plus military service experience. Experience supporting and developing affirmative litigation referrals and collaborating with counsel on fraud-related legal actions. Demonstrated ability to manage multiple high-priority investigations and case assignments simultaneously while meeting critical deadlines. Experience handling large-scale, complex, and high-exposure fraud investigations from initial referral through resolution. Extensive knowledge and experience in all levels of claims investigation or fraud investigation and regulatory reporting requirements. Knowledge of anti-fraud analytics programs relates to fraud prevention and identification. Thorough understanding investigative tools and techniques to guide and coach special investigators. Demonstrated ability to build and maintain collaborative relationships with internal and external partners and business areas. Demonstrated management skills and the ability to demonstrate monthly productivity and cycle time outcomes from investigations assigned to the SIU team. Ability to prepare and present training sessions and case outcomes. Demonstrated experience facilitating and managing projects and teams What sets you apart: US military experience gained through military service or gained as a military spouse / domestic partner. Compensation range: The salary range for this position is: $119-310 - $228,040. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com. Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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• Independent Living Systems

  

  Lead Agency Case Manager

  hace 6 días

  Miami

  Job Description We are seeking a Lead Agency Case Manager to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Lead Agency Case Manager plays an essential role in overseeing and coordinating comprehensive case management services within the agency to ensure clients receive effective and timely support. This position is responsible for developing individualized care plans, and collaborating with multidisciplinary teams to address the complex needs of clients. The Lead Agency Case Manager is responsible for promoting effective education, self-management support, and timely healthcare delivery to achieve optimal quality and positive outcomes. The Lead Agency Case Manager ensures compliance with regulatory standards and agency policies while advocating for member rights and resources. Ultimately, the Lead Agency Case Manager drives the agency’s mission by enhancing member well-being through effective case management, leadership and coordination. Minimum Qualifications: • Bachelor’s degree in Social Work, Psychology, Human Services, or a related field., • Minimum of 1 year of experience in case management or a related role., • Experience working with older adults, individuals living with Alzheimer's disease and related dementias, and family care givers., • Strong knowledge of case management principles, community resources, and relevant legal and ethical standards., • Excellent communication, organizational, and interpersonal skills., • Proficiency in case management software., • Bilingual in the prominent language of the population being served., • Relevant experience may substitute for the educational requirement on a year-for-year basis. Preferred Qualifications: • Master’s degree in Social Work (MSW), Counseling, or a related discipline., • Certification in Case Management (CCM) or Licensed Clinical Social Worker (LCSW) credential., • Experience working with diverse populations and in multidisciplinary team environments., • Familiarity with data analysis and quality improvement methodologies. Responsibilities: • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence., • Assess clients in a comprehensive manner in person., • Develop, implement, and monitor individualized care plans tailored to meet the unique needs of each client., • Coordinate with healthcare providers, social services, and community resources to facilitate comprehensive care and support for clients., • Ensure all case management activities comply with agency policies, ethical standards, and relevant regulatory requirements., • Encourages and provides education and training to caregivers, family members or friends., • Serves as a liaison to providers, members and caregivers for coordination of services., • Completes and maintains a client record with progress reports and forms related to service provision and ongoing documentation., • For ADI participants, provide caregiver support, dementia education, and coordinate dementia-specific services, including respite and other approved supports., • Perform other duties as assigned.

• COMMUNITY HEALTH OF SOUTH FLORIDA INC

  

  MH SPECIALIST I, ADULT CASE MANAGEMENT

  hace 8 días

  Miami

  Job Description POSITION PURPOSE: Optimize the functioning of individuals increasing self-sufficiency and satisfaction in the living, learning, work and social environment of their choice through evaluation, monitor, linkage, and advocacy. POSITION REQUIREMENTS / QUALIFICATIONS: Education/Experience: Graduate from an accredited College or University with a minimum of a Bachelor’s Degree in the human service filed and have a minimum of one year of full time experience working with adults experiencing serious mental illness. Licensure / Certification: DCF/CCMS State Certified or eligible. Maintain current CPR certification from the American Heart Association. Must have a valid Florida Driver’s License. Skills / Ability: Possess knowledge of community resources, Community-Based Organizations and private providers of services to optimize the functions of individual eligible to receive management services. Good documentation skills, computer literate, ability to work independently, excellent interpersonal and communication skills. POSITION RESPONSIBILITIES (THIS IS A NON-EXEMPT POSITION) Provide services to adults suffering from a serious and persistent mental illness who have complex needs and will require services to maintain or improve level of functioning, self-sufficiency and independence for at least one year. Maintain case load of no more than 40 consumers. Evaluate and discuss with supervisor consumer’s continued program eligibility as establish by 65 E 15 Guidelines. Maintain documentation as per 65 E 15; Medicaid and other state and federal regulatory guidelines. Develop and maintain resource database to facilitate linkage, brokerage and access to resources for consumers. Provide goal oriented and individualized supports through assessment, planning, linkage, advocacy, coordination and monitoring. Maintain communication with agencies and resources within the community to facilitate self-sufficiency and independence for consumers. Develop and updates Comprehensive Assessment and Comprehensive Service Plans reflecting individualized measurable goals in a timely manner (within 30 days of initial contact). Monitors and updates Comprehensive Service Plans when there is a significant life/status change in consumer’s life but at a minimum of every six months from initial plan. Complete a home visit during the development of the Comprehensive Assessment and prior to the completion of the CSP; and conduct home visits at least every other month for every consumer provided that it is approved by the consumer. Prepares and maintain documentation in compliance with contracting and regulatory agencies and not limited to verbal instructions from direct supervisory staff. Maintains consistent productivity, at least 80% of the established agency goal, per month. Submit/file required documentation in the expected timely manner. Maintain face-to-face contact at least once per month with consumers. Assume responsibility for the maintenance and auditing of all assigned consumer’ Case Management records. Participate in Performance Improvement Program and Peer Review as required. Procure contingency funds as provided by DCF procedures. Attends in-service and seminars to improve knowledge and skills in regard to position. Attends mandatory in-service training within prescribed time frame. Reports on a timely manner as requested by supervisor. Coordinate and assist consumers in obtain necessary transportation. Maintains strong interpersonal relationship with peers, supervisor and other department personnel. Adheres to BHCC’s Policies and Procedures. Participates in BHCC’s Committee Meetings. Provides coverage in the absent of peers and maintains collaborative teamwork. Provide liaison and support to families/care givers of consumers, maximizing their involvement in the Case Management planning progress. Monitor consumer compliance with substance abuse treatment recommendations, and develop alternative plan of service if necessary. Report incidences and/or occurrences within the proper time frame as establish by CHI Policies and Procedures. Develop, document and up-date Mental Health Outcome Forms (every quarter) and FAR (every six months) for all enrolled consumers. Monitors and advocates for consumers needs while at CSUs, hospitals or RTF and upon discharged. Participate in CHI activities and special events as available, i.e. culture day, health fairs, holiday celebrations, etc. Collaborate in crisis management situations with other BHCC staff, consumers and appropriate community supports. Develop and obtain housing resources within the community and share information with peers. Complete and submits weekly a daily report of activities to the supervisor. Communicates and solves problems through the proper chain of command. Provides services in a sensitive non-judgmental and non-discriminatory manner to a diverse population. Provide case management services for residents of the Shelter Care Plus Program(s). Attend HMIS User meetings as directed/necessary. Access, update and maintain consumer information in the HMIS Service System. Prepare and maintain all documentation in compliance with Shelter Plus Program and provide input and support to appropriate staff when needed for grant submission/review/renew. Adheres to Confidentiality Policies and Procedures / HIPAA Regulations. Provides accurate and timely documentation in patient charts within the same day of intervention. Completes B&E (billing and encounter) forms within the same day of intervention. Reports to work on time and ready to work with minimal absenteeism. Calls and report to supervisor when absence/tardy due to illness and/or family emergencies. Promotes a positive work environment. Maintains flexibility in regard to expected or unexpected changes in the work environment. Responds to administrative task appointments. Performs other duties as assigned.

• Westchester General Hospital

  

  Case Manager

  hace 28 días

  Miami

  Job Description POSITION SUMMARY: JOB SUMMARY: Assess psycho-social needs of patients assigned and initiates necessary arrangements for needed resources and/or discharge plans. Provides counseling to patients and families for care required by patients after discharge. Performs assessment/evaluation of treatment needs. Conducts group therapy sessions and/or individual therapy. ESSENTIAL RESPONSIBILITIES: Counseling individual patients and family members. Makes recommendations and referrals to home health and community agencies as needed. Is knowledgeable in “Baker Act” and other Mental Health Laws. Coordinates discharge planning according to discharge criteria for all patients and re-evaluates and modifies the discharge plan as needed. Assists with program planning, development and evaluation. Performs intake assessment/evaluation of treatment needs, including completion of psychosocial history and creation of treatment plan per hospital policy. Assists in determining eligibility of social, medical, financial and other services to meet the patient’s needs. Communicates psychosocial aspects of treatment with the multi-disciplinary team and acts as a resource for treatment planning and regarding patient/family involvement. Monitors compliance and observations for adverse reactions to medications within the elderly population. Monitors and ascertains the therapeutic modalities that are conducive to meeting the needs of the elderly patient. Meets and consults with physicians regarding patient's treatment plans and needs to meet the patient's psycho-social and discharge needs. Implements crisis intervention measures when indicated, including behavioral and individual counseling for suicidal ideation or controlling aggressive behavior. Conducts individual and group therapy sessions. Proving Insight Oriented group; specialty groups as indicated and individual sessions for all assigned patients Participates in researching community resources and evaluates them thru site visits to the agencies/facilities utilized as referral sources. Participates in cross-functional CQI, safety and infection control studies as assigned. Required to have flexibility of schedule to meet the needs of the patient and family members for purpose of discharge planning, counseling, etc. Occasionally may require overtime. Performs other assigned duties as required. SKILLS AND ABILITIES: • Address age specific needs of the adult and geriatric population in all intervention, assessment, and service delivery coordination., • Maintains a professional level of conduct and appearance., • Practices good public and guest relations by displaying a friendly and cheerful manner., • Displays good judgment and tact when dealing with complaints and situations where the policies of the hospital are being enforced., • Use personal judgment and specialized knowledge to give information to people., • Communicate well. Speaks clearly and listens carefully., • Adheres to policy and procedures as set forth by the hospital., • Maintains confidentiality of patient information., • Assist patients and their families in their needs., • Ability to multitask., • Uses eyes, hands, and fingers accurately while operating a switchboard or computer keyboard. PHYSICAL DEMANDS: Sedentary Work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, or pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. ENVIRONMENTAL CONDITIONS: Inside: Protection from weather conditions but not necessarily from temperature changes. REASONING DEVELOPMENT: Be able to apply principles of rational systems to solve practical problems and deal with a variety of concrete variables. Interpret and direct a variety of instructions furnished in written, oral, diagrammatic or schedule form. MATHEMATICAL DEVELOPMENT: Add, subtract, multiply, and divide all units of measure. Perform the four operations with like common and decimal fractions. Compute ratio, rate, and percent LANGUAGE DEVELOPMENT: Reading: Read and understand instructions, safety rules, etc. Writing: Write reports with proper format, punctuation, spelling, and grammar, using all parts of speech. Speaking: Speak with poise, voice control, and confidence, using correct English and well-modulated voice. RELATIONSHIPS TO DATA, PEOPLE AND THINGS: Data: Coordinating: Determining time, place and sequence of operations or actions to be taken based on analysis of data; executing determination of and/or reporting on events. People: Maintaining harmonious relations among coworkers and other people and promoting efficiency. Things: Handling: Using body members, hand tools, and/or special devices to work, move or carry objects or material. QUALIFICATION: Education and/or experience: Associate’s degree in nursing, bachelor’s in nursing preferred A minimum of two years of inpatient hospital experience with CM/UR/DCP experience preferred

• Westchester General Hospital

  

  Clinical Coordinator

  hace 28 días

  Miami

  Job Description JOB SUMMARY: To verify and monitor patient insurance benefits, authorization, and enter information required into the computer. ESSENTIAL RESPONSIBILITIES: Verifies and obtains all authorizations and necessary pre-certifications from insurance companies. Informs Supervisor about patients who are underinsured or without insurance Perform verification of Medicare coverage and limits on all Medicare accounts of inpatients. Communicates benefit information with the attending physician. Determines patient review dates according to established diagnostic criteria. Maintains accurate patient insurance information. Keeps informed of all new registration procedures. Performs quality reviews on all financial files on a daily basis. Participates in Discharge Planning Meeting Daily. Maintains established departmental policies and procedures, objectives, performance improvement program, safety environmental and infection control standards. Notifies supervisor concerning admissions that do not meet the hospital financial policy criteria. Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients. Participates in educational programs and in-service meetings as required. Prepares statistical reports. Performs all related duties as requested or assigned. Keeps informed on the “Baker Act” and Mental Health related laws. Strives to communicate effectively and courteously with all groups as delineated by interactions. Immediately reports to the supervisor any occurrences or situations that are out of the norm. Should participate in Quality Improvement activities as oriented by Supervisor. SKILLS AND ABILITIES: • Speak clearly and listen carefully., • Use personal judgement and specialized knowledge to give information to people., • Communicate well with the diverse population we serve., • Ability to multitask., • Provide excellent customer service., • Provide solutions to problems., • Use eyes, hands, and fingers accurately while operating a switchboard or computer. PHYSICAL DEMANDS: Sedentary Work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, or pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. ENVIRONMENTAL CONDITIONS: Inside: Protection from weather conditions but not necessarily from temperature changes. REASONING DEVELOPMENT: Be able to apply principles of rational systems to solve practical problems and deal with a variety of concrete variables. Interpret and direct a variety of instructions furnished in written, oral, diagrammatic or schedule form. MATHEMATICAL DEVELOPMENT: Add, subtract, multiply, and divide all units of measure. Perform the four operations with common and decimal fractions. Compute ratio, rate, and percent. Draw and interpret bar graphs. Perform arithmetic operations involving all American monetary units. LANGUAGE DEVELOPMENT: Reading: Read and understand instructions, Patients’ Rights, etc. Writing: Write reports with proper format, punctuation, spelling, and grammar, using all parts of speech. Speaking: Speak with poise, voice control, and confidence, using correct English and a well-modulated voice. RELATIONSHIPS TO DATA, PEOPLE AND THINGS: Data: Compiling: Gathering, collating, or classifying information about data, people or things. Reporting and/or carrying out a prescribed action in relation to information are frequently involved. People: Speaking-Signaling: Talking with and/or signaling people to convey or exchange information. Includes giving assignments and or directions to helpers or assistants. Things: Operating-Controlling: Starting, stopping, controlling and adjusting the progress of machines or equipment, setting up and adjusting the machine or materials as the work progresses. Using body members, and/or special devices to work, move or carry objects or material. QUALIFICATION: An Associate Degree minimum. Specific Preparation: Specific Preparation includes an occupationally significant combination of, or essential experience in hospital admission or customer relation. On the job training or equivalent training in the admitting process. Be familiar with medical terminology. Be proficient in using a typewriter and computer for data processing. Minimum 1 year experience in hospital or mental health setting. Bilingual (English/Spanish) desired.

• Larkin Community Hospital

  

  Clinical Coordinator (Full-Time)

  hace 1 mes

  Miami

  Job Description Job Summary The Clinical Coordinator for the Partial Hospitalization Program (PHP) provides coordination and oversight of clinical services for adults receiving outpatient behavioral health treatment. This position works collaboratively with an interdisciplinary team to ensure the delivery of high-quality therapeutic services, assist with treatment planning, monitor patient progress, and maintain compliance with hospital policies as well as state and federal behavioral health regulations. The Clinical Coordinator plays a key role in supporting patients with serious emotional disturbances and facilitating a safe, structured therapeutic environment. Minimum Qualifications: Master’s Degree from an accredited university in Counseling, Social Work, Psychology, or a related human services field. One (1) year of full-time or equivalent experience working with adults with serious emotional disturbances. BLS Certification (American Heart Association). Must have reliable transportation and must have a valid Florida Driver's License. Licensure: Licensed preferred (LMHC, LCSW, LMFT, or equivalent). Registered Intern acceptable. Required Knowledge, Skills, and Abilities: Knowledge of and compliance with state and federal statutes, rules, and policies that affect the target population. Excellent verbal and written communication and interpersonal skills. Strong ability to work effectively with a multi-disciplinary team of clinical staff and support personnel. Ability and willingness to work closely with diverse populations, including emotionally disturbed adults and their families. Ability to work independently as well as collaboratively in a team environment. Strong documentation, organization, and time management skills. Work Schedule: Monday - Friday (40 hour weeks) 8:00am - 4:30pm Hollywood Campus

• Miami Family Law

  

  Case Manager

  hace 22 días

  Miami

  Job Description Miami Family Law Group is a fast moving, technology forward legal practice handling family law, probate, guardianship, and estate planning. We are looking for a driven, detail obsessed Case Manager who keeps cases moving, catches problems early, and communicates clearly at every level of the team. Our firm runs on three things: matter stages, tasks, and case status. When those three are accurate and moving, clients are happy and the team wins. Your job is to make sure that never slips—and to be the first to know when it does.What You Will Own • Monitor and manage matter stages across family law, probate, guardianship, and estate planning cases, • Identify bottlenecks and stalled cases, then drive them forward, • Enforce case movement standards and hold the team accountable to KPI benchmarks, • Maintain accurate matter records, update case statuses, and track milestones in Clio, • Run reports and surface key data for management and production team reviews, • Flag at risk cases and escalate before they become a problem, • Audit workflows to ensure nothing falls through the cracks, • Communicate issues, wins, and trends clearly to both leadership and the paralegal team What You Bring • Experience with family law, probate, guardianship, or estate planning matter stages, • Strong grasp of case lifecycle management from open to close, • Comfortable with billable hour environments and production metrics, • Proficient with legal practice management software — Clio experience preferred, • Exceptional organizational skills and consistent follow through, • Clear, professional communicator — written and verbal, • Self starter who executes independently and does not need constant direction You Will Stand Out If You • Have managed a team or supervised paralegals, • Can read a workflow and spot what is missing, • Are comfortable presenting reports to leadership, • Balance big picture thinking with granular task tracking, • Have worked in a paperless, technology forward legal environment, • Are energized — not stressed — by high volume, fast paced work What We Offer • $75,000 to $85,000 base salary based on experience, • Quarterly performance bonuses tied to individual results, • Technology driven, collaborative work environment, • Clear expectations, real accountability, and room to grow, • A team that values people who deliver Requirements • Case management: 3 years (Required), • Family law: 3 years (Required), • Wills, trusts & estate law: 3 years (Required), • Law office: 3 years (Required) Benefits Benefits include: • 401(k) with company match, • Health insurance, • Health Care Flexible Spending Account (FSA), • Life insurance, • Short-term and long-term disability insurance, • Educational course reimbursement, • Paid time off (PTO), • Paid holidays

• Chapman Partnership

  

  Case Manager

  hace 19 días

  Miami

  Job Description SUMMARY: Chapman Partnership’s case management services will be guided by ethical principles respecting autonomy, dignity, privacy and the rights of the individuals we serve. Case managers provide case management services to residents and families, to meet their social and emotional needs as they impinge on their medical, social, psychological, economic, and spiritual condition, and the safe transition from one environment to another. DUTIES AND RESPONSIBILITIES: • Assess residents and/or families for appropriate services and formalize individual service and goal plans., • Participate in case conferences regarding resident’s status, needs, outplacement, and discharge plan., • Provide services to restore residents to optimal social environment, utilizing community agencies and resources in helping residents stabilize and regain independence., • Provide outplacement and follow up services with resident., • Prepare and keep current a case record on each resident in Homeless Management Information System (HMIS)., • Prepare statistical reports and complete a variety of reports for distribution., • Manage customer satisfaction surveys, and prepare and analyze productivity and performance reports., • Assist with transportation needs for residents. Inspect vehicles for proper working conditions and report maintenance needs, as necessary., • Performs other assignments or tasks as deemed necessary. QUALIFICATIONS: • Bachelor’s degree in social services, human services or related field; or equivalent experience. Certification preferred., • Minimum of one (1) year practical experience working in social services, human services and/or with the homeless population. Two (2) years’, practical experience may substitute for the education requirement., • Valid driver license (State of Florida), adequate level of car insurance as required by law and clean driving record. KNOWLEDGE, SKILLS, AND ABILITIES: • Knowledge of social services, counseling and behavior sciences., • Overall understanding of the issues affecting our residents., • Experience working with vulnerable populations., • Ability to be professional, flexible, respectful, and calm., • Ability to work well with others., • Ability to lead by example., • Ability to provide effective support and guidance to further develop professionals within the Program Services department., • Exceptional verbal and written communication skills., • Computer Literate., • Solid social service management skills., • Bilingual in English and Spanish and/or English and Creole preferred.