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Our commitment is to deliver excellence and an empathetic human experience to every patient, every family member, every employee, every time. We do this through our Core Values which help in guiding our work every day.
Job Summary: The Case Manager coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdiciplinary Care Transitions (ICT) 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.
Coordinates clinical and psycho-social activities with the Interdisciplinary Team and Physicians to provide comprehensive care coordination and discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning. Promotes effective and efficient utilization of clinical resources.
Monitors all areas of patients' stay for effective care coordination and efficient care facilitation . Conducts medical necessity review for appropriate utilization of services from admission through discharge. Documents all patient review records according to regulatory, legal and coordination requirements.
Performs reviews for third party payors as appropriate.
Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, and case management or psychosocial legal issues that affect patients and providers of care.
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.
Conducts comprehensive, ongoing biopsychosocial assessments of patients and family to provide timely and safe discharge planning. Refers cases where patients and/or family would benefit from additional resource support to the Social Worker, where applicable.
Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
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.
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.
Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from health care services.
Serves on Division committees when requested.
Initiates patient and family education and discharge planning at admission.
Arranges for discharge and post-hospital care of patients through institutions and agencies within the community.
Graduate of an accredited program required.
RN or BSN preferred; OR Masters in Social Work with licensure as required by state regulations; OR Bachelors in Social Work with licensure as required by state regulations
Healthcare professional licensure required as Registered Nurse, OR Licensed Clinical Social Worker (LCSW) OR Licensed Social Worker (LSW) if required by state regulations.
Appropriate certification in Case Management preferred.
Three years of experience in an acute care Medical/Surgical and/or ICU/CCU setting. Prefer experience in Case Management, Quality Management, Utilization Review, or discharge planning.