Per Diem Case Manager II

Job Summary

Care Coordination
- Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians
- Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation
- Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care

Essential Functions

• Serves as a patient advocate
• Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs
• Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
• Captures and coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients’ care throughout the care continuum
• Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning
• Provides comprehensive discharge planning for each patient
• Utilizes critical thinking to develop and execute effective discharge planning
• Coordinates and communicates with patient/family efficiently and effectively
• Conducts medical necessity review for appropriate utilization of services from admission through discharge
• Promotes effective and efficient utilization of clinical resources
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement
• Knowledge of Medicare benefits and insurance processes and contracts
• Knowledge of accreditation standards and compliance requirements
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers

Education

• From an accredited school of nursing in nursing or social work: BSN, MSN, BSW or MSW

Experience

• Experience in healthcare setting in case management, utilization review, or discharge planning