About this position
Position Summary
Responsibility to coordinate clinically complex patient’s care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes, negotiating, procuring and coordinating appropriate services and resources needed by the patients, and at key points, intervening to address and resolve issues/concerns. Key in ensuring appropriate sequencing of treatment goals and implementation of a comprehensive discharge plan. Demonstrate knowledge and skills necessary to provide case management services to the patient population experiencing rehabilitation needs.
Position Supervisory Responsibilities
Supervises the following positions: None
Position Qualifications Minimum Qualifications:
Current, valid, and active license to practice as a Registered Nurse, MSW or Licensed Social Worker in the
state of employment required.
Current BLS certification from a CORALVITA-approved vendor required.
ADDITIONAL QUALIFICATIONS/SKILLS:
One (1) year of case management experience preferred. Previous LTAC experience preferred. CCM or ACM certification preferred.
Working knowledge and ability to apply professional standards of practice in job situations.
Must be assertive and personable with the ability to balance the complex challenge of delivering quality, cost-appropriate, and service-oriented outcomes.
Demonstrates comprehensive knowledge of the principles and concepts of case management and applicable standards of voluntary and regulatory agencies for review activities.
Proficient in collecting and retrieving material from medical records.
Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models.
Communication skills, both written and oral, must be outstanding and practiced with all internal and external business relationships.
Interpersonal relationship abilities must be highly refined with negotiation and problem solving skills at a very high level.
Must possess strong clinical assessment and process skills.
Critical thinking skills must be demonstrated in all situations. Ability to project a professional image.
Knowledge of regulatory standards and compliance requirements. Strong organizational, prioritizing and analytical skills.
Ability to make independent decisions when circumstances warrant.
Working knowledge of computer and software applications used in job functions. Freedom from illegal use of and effects of use of drugs and alcohol in the workplace.
Certificates, Licensures, Registrations
Current, valid, and active license to practice as a Registered Nurse, MSW or Licensed Social Worker in the state employed. CCM preferred. Current BLS certification from a CORALVITA-approved vendor required.
Attendance
Regular and punctual attendance.
Language Skills
English is the primary language of the facility. Ability to read and write, communicate clearly with co-workers and customers and to respond to appropriate questions regarding work process or work product.
Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to compute rate, ratio, and percent.
Reasoning Ability
Ability to apply common sense understanding to carry out instruction furnished in written, oral and/or diagram form. Ability to define and solve problems and collect data.
Essential Functions and Responsibilities
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to identify and implement components of the Case Management process. Identify learning needs and teach patients and families. Ability to communicate and collaborate with a variety of teams and individuals. Working knowledge and ability to apply professional standards of practice in job situations
Job Function | Approximate % of Time |
Facilitate case management: assess patients’ clinical level of care needs assuring appropriate treatment, documentation and level of care collaboratively; initiate and review interventions indicated to enhance movement toward goals and quality improvement of care including psychosocial issues, maintain appropriate records for oversight agencies, serve as a liaison with community entities to promote services and opportunities for the patient, identify problem areas and develop appropriate treatment referral options. Work closely with hospital staff and nurse liaison to ensure delivery of quality, cost-appropriate, and service-oriented outcomes. Ongoing monitoring for optimal quality and appropriateness of care and continued stay at hospital using approved criteria. Advocates for clinical documentation improvement initiatives, and appropriate DRG assignment in the hospital.Actively participate in interdisciplinary team meetings. |
30% |
Education and Communication: Provide education, support and training to patients, families, employees and medical staff on case management function. Provide appropriate explanations and assistance to patients and families during the entire patient stay and case management process. Provide education and support to patients and families on case management function, treatment planning, patient rights, advanced directives, grievance procedures, community health and social agencies available to meet/address discharge needs and/or psychosocial issues, including their eligibility criteria and availability status. Ensure that case management systems, utilization review practices and discharge planning processes are timely and appropriate. Participate in select data collection to track and trend practice patterns, data analysis and identification of variances. Consistently document effectively. Advocate for patient rights in all areas. |
25% |
Admission: Work closely with Admissions and/or other financial staff to formulate plan of care for pre-certification of potential admission. Review pre-admission screening for utilization review, funding and discharge planning issues. Provide ongoing communication | 20% |
Job Function | Approximate % of Time |
as required regarding funding issues and assure continued fiscal appropriateness of patient admissions and continued stay reimbursement. |
|
Discharge Planning: Initiate discharge planning activity at the time of admission. Determine discharge care needs through assessment and interdisciplinary team membership. Determine need for home evaluation and, as appropriate, initiate referral to selected community care agencies providing information pertinent to continued care needs in a timely and organized manner. Inform patient/family and review clinical discharge planning options and plan with physician when appropriate. Provide follow up contact to patients who are discharged with multiple or complex discharge planning needs to assure that coordinated services have begun and are meeting patient’s needs. |
20% |
Remain current with literature related to departments for which responsible and maintain an updated methodology, tools, manuals and criteria as necessary and appropriate. |
5% |
Additional Responsibilities
- Maintain excellent working relationships with co-workers, health care professionals and other health related facilities and organizations as appropriate.
- Promote Organization philosophy, mission and objectives within and to patients and customers outside the hospital.
- Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time. Willing to seek out new methods and principles and be willing to incorporate them into existing practices.
- Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions.
- Demonstrates honesty and integrity at all times in the care and use of patient and hospital property.
- Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies.
- Demonstrates satisfactory level of interpersonal skills to interact and deal tactfully with facility staff, Administration, patients, families, customers, vendors, and government agencies.
- Ability to carry out essential functions of this position with or without reasonable accommodation.
- Access continuing education opportunities appropriate to responsibilities.
- Appropriately accesses the resources of the company’s corporate offices for consultation and support. Routinely shares professional knowledge with staff, managers and hospital personnel.
- Attend and participate in facility meetings.
- Knowledge of emergency and disaster procedures of the facility.
- Participate in hospital wide safety program identifying risks to patient safety and reducing healthcare errors.
- Participates in relevant in-service training sessions.
- Perform other duties as assigned.
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Patient Rights | Promotes and protects patients’ rights; treats patients with dignity and respect; reports suspected abuse or neglect. |
Leadership | Demonstrates willingness to try new tasks; generates new ideas for change; evaluates and recognizes priorities; communicates and models organizational values; fosters high performance. |
Performance Improvement | Applies performance improvement methods and techniques; assists in data collection; identifies processes for improvement in daily work; and participate in new employee orientation. |
Environment of Care | Demonstrates understanding of fire and emergency procedures; participates in fire and disaster drills; demonstrates understanding of safety and security procedures; applies safety and security precautions; demonstrates understanding of hazardous materials plan; demonstrates proper use of equipment. |
Infection Control | Applies hand-washing principles during daily work; demonstrates understanding of isolation precautions; recognizes signs and symptoms of infection and complies with the employee health program; demonstrates understanding of the process for identifying and handling infectious waste; maintains personal hygiene; complies with OSHA standards in the work place; and demonstrates understanding of cross-contamination. Complies with applicable health screenings. |
Information Management | Enters or records data timely and accurately; protects confidentiality of patient information; protects data against loss or destruction; reports suspected violation of security/confidentiality issues. |
Interpersonal Skills
Demonstrates active listening techniques; gains support through effective relationships; treats others with dignity and respect; seeks feedback; participates in processes to measure effectiveness, efficiency, and service; and maintains reporting mechanisms.
Continuing Education
Attends in-service and education programs; attends continuing education required for maintenance of certification.
Physical Demands and Work Environment
The physical demands described here represent those that must be met by an employee to successfully perform the essential functions of this job. The noise level in the work environment is usually moderate.