Responsible for the assessment, coordination, planning and implementation of case management services. Cooperates and works with others to plan and complete job duties, in the best interest of the patient, the facility, and clients involved in our day-to-day activities. Communication between physician, patient, family members and facility health care team members is facilitated by the case management personnel, in order to provide the best options for care and progression towards discharge.
Develops case management recommendations consistent with sound medical and financial management. Performs admission, concurrent discharge planning and retrospective reviews to obtain and document medical necessity and appropriate level of care determinations. Utilizes approved criteria for patient admissions, observations, and out-patient processes. Utilizes clinical assessment skills and knowledge of patient care to evaluate patient needs and care given. Channels services to network and out-of-network providers, depending on client's needs. Performs data entry and data collection to support faculty's needs and document variances and outcomes. Participate in committees and meetings, including care planning and utilization reviews. Identify and report concerns related to processes at both unit and at facility levels. Establishes and maintains professional rapport with providers, patients, and public agencies. Performs other duties as assigned.
Education and Training: Graduate of an accredited school of nursing or social work. Preferred Bachelors Degree in Nursing or LMSW. Experience preferred, minimum 3 years clinical and 1 case management. Utilization review preferred but not required. Excellent communication skills needed; proficiency with PC-based systems and software programs; problem-solving analytical ability, communication and interpersonal skills important. Knowledgeable regarding Federal, State and Third party regulations and standards (such as JCAHO, OIG). Good organizational skills and teamwork skills also needed. Must be willing to participate in unit and facility projects and activities. Must be willing to work across departmental boundaries and facilitate problem-solving resolution. English/Spanish dual language ability preferred.