Case Manager

Department: 257940 - Case Managment

Job Code: CLN

Schedule: Per Diem

Shift: Day shift

Hours:

Job Details:

The Case Manager is accountable to meet the patient's needs and promote efficient proper use of resources by working with the physician and the health care team to insure an appropriate transition to the next level of the continuum. The case manager is accountable for a designated patient caseload to plan effectively in order to meet the patient's needs, manage the length of stay, and promote efficient utilization of resources through collaboration with the patient and/or family and all members of the health care team.

Assess and evaluate patients all patients on admission and continued stay for acute care criteria, by application of approved utilization acuity criteria. Communicates with appropriate parties regarding problems identified with the patient meeting acute care criteria immediately. Documents findings.

Serve as a clinical resource for the health care team to ensure proper placement of the patient in the continuum; coordinating all referrals as it relates to the patient's continued care needs and ensuring communication with physicians related to those referrals.

Additional functions to this role include facilitation of clinical information necessary for certification and/or payer authorization for the admission and throughout the entire hospitalization.

Communicates required clinical information with insurance companies to obtain authorization for proposed services (i.e.: admission, continued stay, transfer, home health, or other services).

Meets with patients and/or families within 36 hours of admission to assess, evaluate and identify needs at discharge.

Collaborate with the physician and other members of the health care team to plan and facilitate a realistic discharge plan.

Develop discharge plan based on interaction from all parties involved with the patient. Monitors and makes adjustments as needed throughout hospitalization.

Collaborates with Resource Coordinator to facilitate discharge plans.

Develops and maintains proficiency, and routinely utilizes the software programs utilized by department and the Health System for documentation and referral creation. Ensures referrals are complete when forwarded to community sources.

Proactively monitors patient activity, and identifies and resolves delays and obstacles to discharge. Monitors length of stay and documents avoidable days.

Documents according to Department policy, ensuring standards are upheld and script is clear and concise so that the health care team is aware of the ongoing discharge plans.

Acts as the liaison with the physician and the health care team and community agencies to facilitate plan and/or problem solving and coordinate services for the patient.

Coordinates transfers to other facilities using Health System transfer standards.

Refers appropriate cases for social work intervention based on department criteria.

Follows up with those patients after discharge that the Case Manager has identified as high risk or has a history of frequent admissions to insure appropriate discharge plan.

Demonstrates good communication skills and positive guest relations with patients, families, physicians, and all other associates within the Health System.

Demonstrates a commitment to the organization and the Case Management Department. Reacts to change productively. Actively participates in performance improvement activities.

To effectively fulfill the requirements of this position, candidate must have:

Current State of Florida licensed Registered Nurse or Bachelors Degree or Masters Degree required.

A minimum of 3 years clinical experience in the area to which assigned, and current working knowledge of discharge planning, utilization management, case management, performance improvement and reimbursement issues.

Medical Social Worker with previous acute care experience.

Certified Case Manager or related Case Management certification preferred. Recommend Case Management Certification and/or advanced training in Case Management attained within 24 months from accepting the position as Case Manager.

CPR certification required. Strong analytical, organizational, time management and computer skills.

Excellent interpersonal communication and negotiation skills.

Ability to work independently and exercise sound judgement in interactions with physicians, payers, patients and families.

Must have knowledge of utilization management principles and a working knowledge of InterQual, Milliman & Robertson (M & R) criteria.