Case Management Coordinator - FT

Improving Lives Together

Magruder Hospital offers competitive wages with a comprehensive benefit package available to both full-time and part-time employees. We provide a full health plan and generous time off that includes Holidays, Vacation, Sick, Personal, and even your Birthday! Our culture and family friendly work environment truly set us apart- apply today for an opportunity to join our team and help serve this great community!

Ensures coordination and continuity of care through effective transitions of care management as patients move in and out of the inpatient environment. Coordinates admissions/discharges to our Transitional Care Program. Supports patients and team in the care continuum.

• Leads the team of case managers through discharge planning and ulization review, coordinating the provision of care and services, to maximize the patient’s potential with her/her social context.
• Interacts professionally with patients, families, physicians, other hospital staff, and community agencies.
• Determines need for social services intervention and initiates services for inpatients, observation patients, transitional care patients, outpatients including ambulatory surgery patients, physician practice patients when requested, and emergency department patients. This includes assessment related to suicide ideation.
• Counsels patients and/or families regarding interpersonal, financial, and rehabilitation issues as they affect the patient’s health.
• Encourages understanding and adherence by both staff and patients to the organization’s philosophy on patient right and responsibilities
• Assists Patients and/or families in exercising their rights to file grievances/concerns while providing assistance to immediately resolve concerns
• Markets the Transitional Care Unit (TCU) Program by collaborating with the Director of Community Outreach and visiting outside healthcare organizations
• Researches local and regional resources available to Magruder patients and provide education to healthcare team, patients, and families.
• Coordinates continuum of care management of discharged patients at high risk for return with referrals to community health navigator and other outpatient clinical teams available at Magruder Hospital and clinics.
• Creates and implements processes, procedures, continuum of care plans for supporting patients failing outpatient treatment and the need for long term placement.
• Collaborates with nursing leadership on utilization of resources and process improvement to improve length of stay, discharge readiness, and reduction of readmissions.

• Monitors documentation and works closely with the medical staff for appropriate level of care utilizing MCG criteria for admission justification, discharge assessment, and concurrent reviews and monitors progress throughout the patients hospitalization. Performs utilization review and payor notification in a timely manner, per established department work-flow, CMS, and/or payer-specific guidelines.
• Actively participates in and leads interdisciplinary rounds discharge planning and UR discussions/process. Drives the transition process by identifying transition barriers and collaborates in cprehensive patient-centered care plan development.

• Complies with CMS rules and regulations, Conditions of Participation, and payor-specific guidelines to prevent denials and revenue loss. Manages all concurrent denials, including determination of appeals.
• Complies with federal, state, and local legal requirements by studying existing and new legislation; anticipating legislation; enforcing adherence to requirements; advising management on needed actions; ensures compliance with Joint Commission and other external and internal regulatory agencies.
• Maintains the integrity of confidential patient information in accordance with HIPAA and hospital policy, including accessing, using and disclosing patient information relevant to the individual employee’s job duties. Also maintains confidentiality of other customer and hospital business affairs.
• Adheres to the standards of Magruder Hospital’s corporate compliance policies and seeks guidance and training when necessary to resolve questions about the policies. Reports violations in accordance with corporate compliance and organizational standards.
• Reports to work on time and as scheduled; Shows respect for co-workers by following established break times; Keeps personal conversations and telephone calls to a minimum.
• Travel is primarily local during the business day, although some out-of-area and overnight travel may be expected.
• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

• Other duties as requested or assigned.

• Bachelor’s Degree from an accredited school of Nursing
• Must have experience in case management
• Must be competent with Microsoft Office
• Five years healthcare experience
• Training to work with all age levels, with an emphasis on the geriatric population and their needs.

Preferred:

• Master’s degree in related field

Required:

• Current RN license by the state of Ohio

Preferred:

• Commission for Case Management Certification OR Certified Case Manager

Magruder Hospital is an Equal Opportunity Employer and provides equal employment and advancement opportunities to all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, veteran status, disability, or any other protected class under the law.

Magruder Hospital is a Tobacco and Drug Free Workplace. Any offer of employment will be contingent upon satisfactory completion of pre-employment drug screening, including screening for the presence of nicotine, satisfactory completion of background verification, and the results of a post-offer medical and physical examination.