Job Title: Case Manager
Organizational Unit: Case Manager
Accountability: Clinical Lead Case Management and CNO
Job Summary: To facilitate the patient's hospitalization from pre-admission through discharge by assessing each patient for discharge needs and coordinating services to meet those needs. Perform utilization reviews in accordance with established Hospital UR Plan.
FLSA Classification: Exempt
Screens admissions according to established criteria.
Accepts referrals in coordination with other case manager.
Coordinates the provision of social services and discharge planning to patients, families and significant others, enabling them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from health care services.
Fosters team planning of patient care services.
Chairs multidisciplinary team meetings.
Performs chart reviews using Interqual criteria.
Review of DRG assignments.
Completes home care and DME referrals.
Provides clinical information to insurance companies upon request.
Notifies Infection Control Practitioner of patients admitted with infectious disease.
Coordinates the referral of patients and families to appropriate community, social services, residential care and rehab facilities and organizations.
Assists patients and families with evaluation and placement in Long Term Care Facilities.
Maintains a record in each referred patients chart including an initial assessment and on-going case activity.
Provides supportive counseling, information and referral to patients dealing with illness related problems.
Provides services to Emergency Room, ambulatory surgery, maternity and out patients upon request.
Contacts the Medical Director or UR Physician of UR issues as needed.
Develops and maintains harmonious working relationships with other departments: addresses interdepartmental issues.
Represents the hospital on assigned hospital committees.
Insures staff awareness of services available by maintaining current lists of agencies.
Completes assigned competencies annually.
Participates in performance improvement activities as directed.
Actively participates in Core Measure Process.
Completes chart reviews for performance improvement studies.
Responsible for insuring patient’s safety and reporting any concerns to the Director of Quality Management.
Meets on a regular basis with the Director of Quality Management.
Participates in departmental VIP activities
Responsible for participation in and the implementation of the organization's Corporate Compliance Plan into all areas of responsibility.
Identifies improvement opportunities so that enhancements in patient care delivery and outcomes can be made.
Collects pertinent and timely data and uses it to improve outcomes.
Focuses on strategies that result in reducing complication, morbidity, and mortality.
Meets with the patient and/or family to ascertain needs and provide and/or arrange for services.
Communicates/notifies patient placement issues/concerns to Director of Quality Management.
Performs UR reviews as assigned.
Maintains a log of insurance company contacts.
Optimizes the provision of quality healthcare that meets the interests of consumers, providers and payers.
Assists our organization in meeting the standards of regulatory and accrediting agencies.
Participates in implementation of new computer programs.
Responsible for understanding and adherence to the Standards/Code of conduct and the Corporate Compliance Plan at St. James Mercy Hospital.
Ensures that all educational requirements related to Corporate Compliance are implemented and adhered to as required by the CCP Education Plan.
The above statements reflect the general duties considered necessary to describe the principle functions of the job identified and shall not be considered as a full description of all the work requirements which may be inherent in this position.
Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions.
Bachelor’s Degree preferred with commitment to begin studies in 1 year.Current Licensure in NYS as an RN.At least two years’ experience in an acute care setting.Good organizational skills.Ability to communicate effectively.Positive attitude.
Ability to read, write and interpret documents in English such as safety rules, operating and maintenance instructions and procedure manuals. Ability to read, analyze and interpret common scientific/trade/technical journals. Ability to respond to common inquiries or complaints from customers, or regulatory agencies. Ability to effectively present information to employees, top management, public groups and/or board of directors.
Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to calculate figures and amounts such as proportions, percentages, rates and ratios.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to move or transfer patients with an individual effort equal to 50 lbs. Should have a full range of body motion to successfully perform all essential functions of the job, meaning you’ll have to stand, walk, bend, kneel, crouch and reach frequently during a 12 hour shift.
Subject to varying and unpredictable situations.
Handles emergency or crisis situations.
May perform emergency care.
Occasionally subjected to irregular hours.
Contact with patients under a wide variety of circumstances.
Potential exposure to chemicals and communicable diseases and related medical waste.
Employee Signature: ________________________________________ Date: _____________________
Created By: Case Manager