Coordinates/facilitates patient care progression throughout the continuum
Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care
Addresses/resolves system problems impeding diagnostic or treatment progress
Proactively identifies and resolves delays and obstacles to discharge
Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge
Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues
Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective
Facilitates the following on a timely basis: completes and reports diagnostic testing, completes treatment plan and discharge plan, modifies plan of care as necessary, to meet the ongoing needs of the patient, communicates to third party payors and other relevant information to the care team
Assigns appropriate levels of care
Completes all required documentation in TQ screens and patient records
Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting
Completes Utilization Management and Quality Screening for assigned patients
Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards
Identifies at-risk populations using approved screening tool and follows established reporting procedures. Monitors LOS and ancillary resource use on an ongoing basis
Takes actions to achieve continuous improvement in both areas
Refers cases and issues to Care Management Medical Director in compliance with department procedures and follows up as indicated
Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients
Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed
Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department
Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care. Manages all aspects of discharge planning for assigned patients
Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician
Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation
Ensures/maintains plan consensus from patient/family, physician and payor
Refers appropriate cases for social work intervention based on department criteria
Collaborates/communicates with external case managers
Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies
Documents relevant discharge planning information in the medical record according to department standards
Facilitates transfer to other facilities as appropriate
Actively participates in clinical performance improvement activities
Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals
Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data
Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team
Uses concurrent variance data to drive practice changes and positively impact outcomes
Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning)
Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently
Leads the development, implementation, evaluation and revision of clinical pathways and other case management tools as a member of the clinical resource/team
Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)
Acts as preceptor/mentor to new hires
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff
Qualifications
Must-Haves
Education: Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred, or graduate of an accredited Master of Social Work program
Current and valid license to practice as a Registered Nurse in the state of Texas
Or Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred
Certification in Case Management required within two (2) years of hire into the Case Manager position
Must have recent acute care case manager hospital experience
Three (3) years of nursing or social work experience acute hospital-based preferred, or three (3) years of experience comparable clinical setting
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Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
Industries
Internet Publishing
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