What are the responsibilities and job description for the Case Manager -- CORPORATE NURSING -- Stonewall Jackson Memorial Hospital position at Mon Health?
Job Summary
The Case Manager collaborates with the physician and all members of the multidisciplinary team to facilitate care:monitors the patient’s progress, intervening appropriately to ensure that the plan of care and services provided are patientfocused, high quality, efficient, and cost effective. The case manager coordinates necessary education and dischargeplans to promote a smooth transition at discharge.
Responsibilities
Service Delivery
Administers the patient denial process and submits to appeals as needed. Uses Interqual criteria guidelines appropriately. Collaborates and communicates with the multidisciplinary team in all phases of discharge planningprocesses, including initial assessment, planning, and implementation. Coordinates, assists and provides information to the medical staff, clinical team, and patients andfamilies as per hospital policies and procedure. Communicates frequently with patients/families concerning the plan of care and dischargepreparation to promote patient satisfaction. Reviews charts daily for readmits. Works closely with social workers to coordinate transitions for patients who are ready for discharge.” Coordinates with social worker in getting Important Message from Medicare signed by patient priorto discharge. Uses initiative and good judgment when referring cases to Coordinator and/or Physician Advisor. Refers cases as appropriate for peer review. Continue to actively monitor quality indicators and refers deficiencies to coordinator. Organizes caseload daily, based on daily census, number of telephone reviews, and complexity ofindividual case management processes. Conducts initial review within 24 hours (or first business day) after admission to determine medicalnecessity and appropriateness of care (severity of Illness and Intensity of service). Demonstrates the ability to exercise independent judgment, along with reference materials, whenperforming certification. Actively contributes as a team member to utilization of resources within the department. Maintains assigned patient caseload evaluation for utilization management, documentationrequirements, and provides information to managed care reviewers and hospital clinical staff. Consistantly reviews charts for correct admission status. Constantly meets with patients to introduce themselves and the role of the case manager. Manages LOS; knowledgeable about expected LOS and is available as a resource to others to assistwith adherence to guidelines.
Documentation
Thoroughly and accurately documents the rendering and results of the Utilization Review process foreach thirdparty payor in a timely manner, based on UR service plan and guidelines, and hospital wide policiesand procedures. Documents case management activities, implementation of plan of care, and discharge planningaccording to established procedures. Ensures documentation is easily understood and timely in nature, as observed by supervisor. Consistently reviews charts for documentation improvement & query opportunities.
Performs Other Duties as Required
Actively participates in the hospital committees. Build relationships with other departments. Attends mandatory in-services, staff meetings, and actively participates in self-education. Completes all required competency assessments on time. Maintains required job knowledge (e.g. licensure and credentials, continuing education etc.). Performs Other Duties as Required.
Knowledge, Skills & Abilities
Light Work: Frequent lifting and/or carrying of objects weighing up to10 lbs with a maximum lifting of 25 lbs.
A minimum of 5 years' clinical experience in a hospital is preferred. Knowledge of,or ability to learn, Quality Assurance, Utilization Review and Management, Discharge Planning, and Home Health utilizationguidelines and methods of application.Demonstrated ability to communicate effectively with Medical Staff and AdministrativePersonnel. Strong leadership and organizational skills. Ability to organize complex information and paperwork systems.Demonstrates problem solving and decision making skills. Demonstrated ability to Interact well with patients/families andother health care workers. Basic typing and computer skills or ability to learn.
Education
- Bachelor's Degree
Credentials
• Registered Nurse (Required)
Work Schedule: Days
Status: 40 hrs per pay
Location: Stonewall Jackson Memorial Hospital
Location of Job: WV:Weston:Stonewall Jackson Memorial Hospital
Talent Acquisition Specialist: Tara D. Larew tara.larew@vandaliahealth.org
