Case Manager - PRN

People

• Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load
• Makes sure the patient's progress is monitored, intervening as needed to ensure the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective
• Facilitates timely completion and reporting of diagnostic testing, treatment plan, and discharge plan
• Assigns appropriate levels of care and completes all required documentation in EPIC and MIDAS
• Serves as a preceptor and implements staff education specific to patient populations and unit processes
• Serves as a resource for case management and social work resources and needs for the department and the hospital

Service

• Reviews medical necessity of admission, continued stay, and resource use
• Identifies when services no longer meet InterQual/Millman criteria and initiates discharge planning
• Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay
• Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement

Quality/Safety

• Documents assessment and interventions efficiently and effectively
• Plans for routine and difficult discharge and anticipates/prevents and manages emergent situations
• Performs post-discharge review by analyzing the inpatient record to ensure compliance with quality indicators
• Intervenes and takes appropriate action to foster real-time compliance with CMS guidelines and other performance measures
• Conducts chart audits and performs peer-to-peer evaluations for continuous quality improvement
• Identifies opportunities to improve patient satisfaction with focus on discharge domain and collaborates with unit leadership to implement evidence-based patient engagement strategies

Finance

• Maintains monitoring of Length of Stay (LOS) for case load on an ongoing basis
• Identifies population and/or service-specific trends impacting LOS and addresses/resolves problems impeding treatment progress
• Contributes to meeting departmental financial targets on scorecard
• Manages all patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital
• Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state and federal agencies
• Responds to requests for information, monitors covered days, and initiates review to assure that all days are covered and reimbursable

Growth/Innovation

• Provides education to unit-based physicians, nurses, and other healthcare providers on any case management topics
• Identifies opportunities for practice changes
• Offers innovative solutions through evidence-based practice/performance improvement projects and shared governance activities
• Identifies and presents areas for innovation, efficiency, and improvement in case management or department operations using evidence-based practice literature
• Completes and updates the individual development plan (IDP) on an on-going basis