Clinical Case Manager

Responsibilities

• Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team.
• Uses knowledge of usual length of stay to initiate a plan for discharge.
• Collaborates and communicates with patients/families related to reimbursement issues and to create a discharge plan.
• Supports the process of patient choice in establishing a discharge plan.
• Uses clinical knowledge and knowledge of anticipated response to treatment to assess patient progression towards anticipated outcomes.
• Communicates and coordinates with the patient/family and health care team to intervene when progression is stalled or diverted.
• Addresses actual/potential barriers to discharge.
• Completes the interventions necessary for discharges to home with self-care, home with services and short-term skilled nursing facility placement.
• Assembles necessary referrals, discharge summaries and pertinent information for placement prior to the day of discharge.
• Actively contributes to, participates in, and follows through on interventions identified in care coordination and complex patient rounds.
• Identifies high risk patients and creates a collaborative plan to address their unique needs.
• Key stakeholder in the patient throughput process, supports safe and expeditious transition of patients.
• Utilizes InterQual (IQ), Milliman Care Guidelines (MCG), or in accordance with CMS rules and regulations for medical necessity criteria to monitor appropriateness of admissions.
• Utilizes appropriate payer criteria to provide recommendation(s) to the attending physician

Requirements

• Strong interpersonal, communication, and negotiation skills.
• Ability to form positive, collaborative relationships with hospital staff, patients and families.
• Ability to effectively negotiate with internal and external providers of patient care services.
• Analytical abilities to assist in obtaining solutions to problems.
• Able to work independently and prioritize work.
• Able to manage multiple priorities.
• Basic knowledge of computers and clinical applications.
• Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.
• Communicate in a clear, concise, and logical manner in oral and written presentations.

Minimum Qualifications

• Licensed as a Registered Nurse in the State of Connecticut.
• Graduate nursing program (Diploma/Associates) BSN preferred or actively working towards BSN.
• Case Management certification preferred.