What are the responsibilities and job description for the RN Case Manager- Part Time Weekdays position at ScionHealth?
Case Managers coordinate patient care through collaboration and communication with the Interdisciplinary Care Transitions team. They follow patients throughout their care continuum, ensuring optimum resource utilization, service delivery, and compliance with external review agencies. Case Managers provide ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and evaluation of individual patient needs. This role enhances patient management and satisfaction by promoting continuity of care and cost-effectiveness through the integration of case management, utilization review, and discharge planning functions.
Key Responsibilities:
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. Appropriately refers high-risk patients who would benefit from additional support. Serves as a patient advocate, enhancing a collaborative relationship to maximize the patient's and family's ability to make informed decisions. Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served. Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs. Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals. Coordinates with the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of patients' care throughout the care continuum.
Discharge Planning:
Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning. Provides comprehensive discharge planning for each patient, utilizing critical thinking to develop and execute effective discharge planning. Coordinates and communicates with patient/family efficiently and effectively.
Utilization Management:
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.
Additional Responsibilities:
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Serves on Hospital and Division committees when requested. 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 to communicate effectively and obtain cooperation/collaboration from hospital leadership, physicians, payors, and other external customers.
Key Responsibilities:
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. Appropriately refers high-risk patients who would benefit from additional support. Serves as a patient advocate, enhancing a collaborative relationship to maximize the patient's and family's ability to make informed decisions. Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served. Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs. Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals. Coordinates with the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of patients' care throughout the care continuum.
Discharge Planning:
Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning. Provides comprehensive discharge planning for each patient, utilizing critical thinking to develop and execute effective discharge planning. Coordinates and communicates with patient/family efficiently and effectively.
Utilization Management:
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.
Additional Responsibilities:
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Serves on Hospital and Division committees when requested. 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 to communicate effectively and obtain cooperation/collaboration from hospital leadership, physicians, payors, and other external customers.
