Case Manager - LTACH

Kentfield, CA 94904

Posted: 11/23/2021 Category: Nursing Job Number: 91961

Job Description


POSITION SUMMARY
Responsibility to coordinate clinically complex patient’ s care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes, negotiating, procuring and coordinating appropriate services and resources needed by the patients, and at key points, intervening to address and resolve issues/concerns. Key in ensuring appropriate sequencing of treatment goals and implementation of a comprehensive discharge plan. Demonstrate knowledge and skills necessary to provide case management services to the patient population ranging in age from 18 years to geriatric experiencing medically complex conditions, general medical-surgical conditions with rehabilitation and wound care needs.
 

POSITION QUALIFICATIONS

Minimum Qualifications:
  • Current, valid, unrestricted, and active license to practice as a Registered Nurse or Licensed Social Worker in the state of employment required.
  • Current BLS certification required.

Additional Qualifications/Skills:
  • Minimum one (1) year of case management experience preferred. Previous LTAC experience preferred.
  • CCM or ACM certification preferred.
  • Working knowledge and ability to apply professional standards of practice in job situations.
  • Must be assertive and personable with the ability to balance the complex challenge of delivering quality, cost-appropriate, and service-oriented outcomes.
  • Demonstrates comprehensive knowledge of the principles and concepts of case management and applicable standards of voluntary and regulatory agencies for review activities.
  • Proficient in collecting and retrieving material from medical records.
  • Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models.
  • Communication skills, both written and oral, must be outstanding and practiced with all internal and external business relationships.
  • Interpersonal relationship abilities must be highly refined with negotiation and problem solving skills at a very high level.
  • Must possess strong clinical assessment and process skills.
  • Critical thinking skills must be demonstrated in all situations.
  • Ability to project a professional image.
  • Knowledge of regulatory standards and compliance requirements.
  • Strong organizational, prioritizing and analytical skills.
  • Ability to make independent decisions when circumstances warrant.
  • Working knowledge of computer and software applications used in job functions.
  • Freedom from illegal use of and effects of use of drugs and alcohol in the workplace.
  • CERTIFICATES, LICENSURES, REGISTRATIONS
  • Current, valid, and active license to practice as a Licensed Practical/Vocational Nurse (if no BSW or MSW) in the state of employment required. Current BLS certification from An approved vendor required.

 

JOB FUNCTION
  • Facilitate case management: assess patients’ clinical level of care needs assuring appropriate treatment, documentation and level of care collaboratively; initiate and review interventions indicated to enhance movement toward goals and quality improvement of care including psychosocial issues, maintain appropriate records for oversight agencies, serve as a liaison with community entities to promote services and opportunities for the patient, identify problem areas and develop appropriate treatment referral options. Work closely with hospital staff and nurse liaison to ensure delivery of quality, cost-appropriate, and service-oriented outcomes. Ongoing monitoring for optimal quality and appropriateness of care and continued stay at hospital using approved criteria. Advocates for clinical documentation improvement initiatives, and appropriate DRG assignment in the hospital.  Actively participate in interdisciplinary team meetings.
  • Education and Communication: Provide education, support and training to patients, families, employees, and medical staff on case management function. Provide appropriate explanations and assistance to patients and families during the entire patient stay and case management process. Provide education and support to patients and families on case management function, treatment planning, patient rights, advanced directives, grievance procedures, community health and social agencies available to meet/address discharge needs and/or psychosocial issues, including their eligibility criteria and availability status. Ensure that case management systems, utilization review practices and discharge planning processes are timely and appropriate. Participate in select data collection to track and trend practice patterns, data analysis and identification of variances. Consistently document effectively. Advocate for patient rights in all areas.
  • Admission: Work closely with Admissions and/or other financial staff to formulate plan of care for pre-certification of potential admission. Review pre-admission screening for utilization review, funding, and discharge planning issues. Provide ongoing communication as required regarding funding issues and assure continued fiscal
  • Discharge Planning: Initiate discharge planning activity at the time of admission. Determine discharge care needs through assessment and interdisciplinary team membership. Determine need for home evaluation and, as appropriate, initiate referral to selected community care agencies providing information pertinent to continued care needs in a timely and organized manner. Inform patient/family and review clinical discharge planning options and plan with physician when appropriate. Provide follow up contact to patients who are discharged with multiple or complex discharge planning needs to assure that coordinated services have begun and are meeting patient’ s needs.
  • Remain current with literature related to departments for which responsible and maintain an updated methodology, tools, manuals, and criteria as necessary and appropriate.

                                                                            

 

ADDITIONAL RESPONSIBILITIES
  • Maintains excellent working relationships with co-workers, health care professionals and other health related facilities and organizations as appropriate.
  • Promotes Organization philosophy, mission, and objectives within and to patients and customers outside the hospital.
  • Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time. Willing to seek out new methods and principles and be willing to incorporate them into existing practices.
  • Demonstrates and understands the importance of and respect for the rights, dignity, and individuality of each patient in all interactions.
  • Demonstrates honesty and integrity at all times in the care and use of patient and hospital property. Demonstrates respect for co-workers and responds to needs of patients by complying with hospital policies.
  • Demonstrates satisfactory level of interpersonal skills to interact and deal tactfully with facility staff, Administration, patients, families, customers, vendors, and government agencies.
  • Ability to carry out essential functions of this position with or without reasonable accommodation.
  • Access continuing education opportunities appropriate to responsibilities.
  • Appropriately accesses the resources of the company’ s corporate offices for consultation and support. Routinely shares professional knowledge with staff, managers, and hospital personnel.
  • Attend and participate in facility meetings.
  • Knowledge of emergency and disaster procedures of the facility.
  • Participate in hospital wide safety program identifying risks to patient safety and reducing healthcare errors.
  • Participates in relevant in-service training sessions.
  • Perform other duties as assigned.

 

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