JOB SUMMARY Responsible for compliance with CMS Conditions of Participation regarding Discharge Planning; Responsible for ensuring compliance with DNV provisions of care regarding discharge planning and patient needs for care, treatment, and services after discharge or transfer are met. Responsible for assisting in carrying out the hospitals Utilization Management Plan; Educates staff regarding effective allocation of the hospitals resources, while encouraging provision of high quality patient care. Coordinates, monitors and evaluates options and services to meet an individual health needs; Provides a full range of case management services in collaboration and communication with other staff members. Assesses, plans, implements, coordinates, monitors, and evaluates options to facilitate the continuum of care.
- Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his/her goals and objectives in a manner that helps others to achieve their goals and objectives.
- Coordinate the integration of social services/case management functions into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
- Conducts review and collaborates with payers and review organizations to ensure appropriate utilization of patient care services from admission through discharge.
- Assist physicians, patients, families, staff and payers in providing care for patient populations that is appropriate, effective, and cost efficient.
- Documents clearly and concisely all contacts and information of the patient case management process in the medical record.
- Educates physicians and staff regarding appropriate level of care and utilization issues to maintain appropriate cost, case and desired patient outcome.
- Introduces self to patient and family and explains clinical case manager role and process for patient and family to contact clinical case manager.
- Participates in the data collection and analysis as required by department, hospital or various agencies.
- Maintains and enhances professional growth and development through attendance at seminars, conferences and continuing education offerings.
- Performs other duties as assigned, including recipient rights advisor/officer.
Minimum Qualifications Associate degree in Nursing, Licensed in the state of Michigan Five (5) years of experience working as a registered nurse in an acute hospital setting.
Knowledge, Skills & Abilities
Working Conditions May experience traumatic situations including psychiatric, dismembered and deceased patients.
Physical Requirements: ;Constantly see/visual acuity, talk/hear; Frequently stand, sit, walk, handle/grasp/feel. Occasionally lift/carry 1 to 50 lbs.