RN or Social Worker, Case Manager: PRN

Position Highlights:

• Work/life balance: 12-hour shifts, variable weekends with support to help manage your personal life while building a career.
• Employee-centric benefits: 401(k), health and wellness offerings, and monthly employee events.
• Lifestyle: Sandusky was voted “Best Coastal Small Town in America” with opportunities to enjoy living and working along the beautiful shores of Lake Erie.

About Firelands Health

Our goal at Firelands Health is to be the best and preferred independent healthcare employer for the Sandusky Bay region. As the area’s largest and most comprehensive resource for quality medical care, we are locally managed and governed as a not-for-profit healthcare facility. We serve the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. Our mission is to provide excellent healthcare, promote community wellness, and improve the lives we serve.

Our Core ACE Values:

• Attitude: We choose to be positive and inclusive every day.
• Commitment: We are committed to exceed the expectations of those we serve.
• Enthusiasm: We will work passionately to make a difference.

About the Role

Under the supervision of the Director, this position is responsible for the implementation of the Case Management process. You will monitor physician documentation and work closely with the medical staff to ensure appropriateness of hospitalization. The role involves identifying potential risk management and utilization issues and reporting findings per departmental protocol. You will be responsible for initial utilization and discharge assessment, completing concurrent utilization review, and monitoring progress through the acute care continuum. Additionally, you will work closely with the Social Worker to identify discharge and transition needs and coordinate discharge planning activities in collaboration with interdisciplinary staff, both internal and external to the organization. You will also support documentation needs by working closely with the Clinical Documentation Specialist and participate in the quality improvement and evaluation process.

Responsibilities

• Make patient rounds with and without physicians to evaluate and assess patient needs, assigning a designated level of risk for identified barriers to the plan of care and discharge/transition needs.
• Review medical records daily to complete utilization review, documenting Admission Justification and Ongoing Plan of Care.
• Arrange for facility cooperation in the delivery of care and awareness of psychosocial needs for resolution of individual cases.
• Interview patients, family members, and significant others to summarize immediate levels of comfort and pending problems that may deter care delivery.
• Act as a liaison between the patient, family, significant others, and hospital staff during periods of crisis.
• Communicate with nursing and medical staff to assess the psychosocial needs of the patient and monitor/oversee the discharge plan.
• Identify discharge needs and barriers to safe discharge goals for patients and their families.
• Maintain current working knowledge of HFAP, COBRA, EMTALA, OSHA, and other regulatory standards.
• Ensure accurate and current documentation in patient medical records.
• Maintain accurate data collection related to the quality of care delivery within the department.
• Work closely with the Social Worker in assigning tasks and responsibilities in the discharge planning process.
• Maintain and update knowledge of community resources in areas of practice.
• Report suspected abuse, neglect, or exploitation prior to hospitalization as indicated by hospital protocol.
• Work with the Clinical Documentation Specialist to identify and update the working DRG as indicated by patient acuity.
• Contact attending physicians to ensure medical documentation meets quality standards and supports appropriate reimbursement.
• Coordinate with medical and nursing personnel to clarify patient medical status and discharge/transition plans, supported by current research and evidence-based practice.
• Refer patients to services required post-discharge (e.g., SNF, Home Health Care).
• Ensure all high-risk and/or complex patients have an interim discharge plan established prior to leaving the facility.
• Propose alternative placement and/or treatment options to facilitate cost-efficient care and quality outcomes.
• Refer patients with special financial needs to appropriate finance personnel.
• Identify clinical or system/process breakdowns and improvement opportunities, documenting them according to the Performance Improvement (PI) plan.
• Intervene and recommend referrals to resolve system/clinical barriers to patient progression, collaborating with other disciplines as needed.
• Ensure compliance with state and federal regulatory standards of care.
• Abstract, track, and trend data related to resource utilization, avoidable tests/procedures, and case management interventions.
• Initiate referrals to the Ethics Committee, Physician Advisor, QA, Risk Management, or legal services as appropriate.
• Assist the Social Worker in initiating advanced directives or provide resources to educate patients/families.
• Demonstrate professional accountability by supporting patient rights, informed consent, and advanced directives.
• Identify patients/families in need of grief or crisis intervention and make referrals as indicated.
• Collaborate with physicians on appropriate clinical documentation to accurately reflect the severity of patients' illnesses.
• Reinforce education with patients/families on the plan of care, discharge instructions, follow-up, and expected outcomes.
• Provide education for team members regarding appropriate utilization of services and levels of care.
• Actively participate in educating healthcare team members on current healthcare economic issues impacting care patterns, reimbursement, and patient outcomes.
• Educate patients and families regarding community resources, access to routine healthcare, and health maintenance.

Requirements

• Registered Nurse, Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) with an active and valid license in the State of Ohio.
• Three to five years of experience in an acute care hospital setting.
• Experience with the case management process.
• Certification in a field related to Case Management preferred.

Benefits

• 401(k) retirement plan.
• Health and wellness offerings.
• Monthly employee events.

Schedule

• 12-hour shifts.
• Variable weekends.