What are the responsibilities and job description for the Case Management Manager position at Pleasant Valley Hospital?
Overview
Provides management oversight of the Care management services at Rivers Health including Case Management, Utilization Management and Social Services.
Duties
- Communicates with Physicians to assure patient meets admission criteria and level of care determination is correct.
- Assesses patient needs for case management intervention through data gathering, treatment plans, resource utilization and cost management. Coordinates patients' process of care throughout the continuum of care.
- Determines the anticipated DRG, length of stay and transfer or discharge date. Communicates and collaborates to manage LOS outliners and observation stay greater than 48 hours.
- Tracks major events in the hospitalization process and discusses with the patient, family or significant others patient progress and outcomes they can reasonably expect.
- Manages referrals to external physician advisor for level of care consultation and physician peer to peer review.
- Identifies patients' individual needs in such areas as social and economic influences, family resources, functional abilities, knowledge needs, potential risk factors, complications and special issues, determine strategies to facilitate appropriate resolution and cost-effective outcomes.
- Serves as hospital liaison to insurance companies. Ensures clinical data is provided to support admission to insurance companies timely. Sends updates as required.
- Identifies and/or coordinates resources patients may need upon discharge, ensures discharge teaching is completed and documented.
- Assumes advocacy role for patients during hospitalization; makes appropriate referrals to community agencies/resources.
- Completes financial clearance including benefits, authorization, clinical submission, etc., on all swing bed and inpatient rehab. admissions.
- Ensures completion of PASSR as required for swing bed admissions.
- Investigates inpatient denials. Takes appropriate action for appeal and maintains required denial statistical data.
- Management oversight of all team members to produce length of stay appropriate to the diagnosis of the patient.
- Ensures all discharge needs are addressed for patients prior to discharge.
Job Type: Full-time
Benefits:
- 403(b)
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
- Weekends as needed
Ability to Commute:
- Point Pleasant, WV 25550 (Required)
Work Location: In person