Case Manager Full Time

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

Care Coordination

Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians

Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation

Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care

Appropriately refers high risk patients who would benefit from additional support

Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions

Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served

Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals

Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients’ care throughout the care continuum

Discharge Planning

Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning

Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning

Coordinate and communicates with patient/family efficient and effectively

Utilization Management

Conducts medical necessity review for appropriate utilization of services from admission through discharge

Promotes effective and efficient utilization of clinical resources

Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor

Other

Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards

Serves on Hospital and Division committees when requested

Knowledge/Skills/Abilities/Expectations

Knowledge of government and non-government payor practices, regulations, standards and reimbursement

Knowledge of Medicare benefits and insurance processes and contracts

Knowledge of accreditation standards and compliance requirements

Ability to demonstrate critical thinking, appropriate prioritization and time management skills

Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software

Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers

Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members

Approximate percent of time required to travel, 0%

Must read, write and speak fluent English

Must have good and regular attendance

Performs other related duties as assigned

Salary Range: $49.83 - $61.96

Education

Graduate of an accredited program required for RN. BSN preferred; or MSW/BSW with licensure as required by state regulations

Licenses/Certification

Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations

Certification in Case Management a plus

Experience

Two years of experience in a healthcare setting preferred

Prefer prior experience in case management, utilization review, or discharge planning

Shift: Day