Case Manager - Care Coordination - Full Time 8 hours Day (Union, Non-Exempt)

JOB ACCOUNTABILITIES

• Actively participates in clinical performance improvement activities.
• Applies approved InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.
• Assists in the compilation of physician profile data regarding LOS, resource utilization, denied days, cost, case mix index, patient satisfaction, and quality indicators.
• 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.
• 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.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; 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:
  • completion and reporting of diagnostic testing,
  • completion of treatment plan and discharge plan,
  • modification of plan of care, as necessary, to meet the ongoing needs of the patient,
  • communication to third-party payers and other relevant information to the care team,
  • assignment of appropriate levels of care,
  • completion of all required documentation in Affinity GUI screens and patient records
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates/communicates with external case managers.
• Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients.
• Captivates patient/caregiver and interdisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration,