JOB SUMMARY: Under the direction of the Director of Case Management, coordinates patient's care from admission, through hospitalization, to post-discharge follow-up with emphasis on collaborative relationships with patients and families, clinical nurses, physicians, social workers and other health team members to best meet the patient's physical, emotional, and spiritual needs. Specifically, the Case Manager uses a problem solving process that includes assessment, problem identification, goal definition, plan development, evaluation and revision of the plan to achieve optimum patient outcomes.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Consistently supports the Mission, Vision and Values of St. Joseph Medical Center.
Follows the St. Joseph Medical Center Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Promotes a culture of safety for patients and employees through proper identification, proper reporting, documentation and prevention of medical errors in a non-punitive environment.
Demonstrates leadership skills including recognition and acceptance of accountability and responsibility for duties and functions within the scope of the practice of the RN; collaboration with other team members towards problem resolution; precise and appropriate verbal and written communication; and behaviors consistent with the role of the professional nurse.
Reviews patient's medical records to collect data pertaining to diagnoses and major procedures performed, evaluates appropriateness of admission, observation and length of stay, and completes required forms.
Performs concurrent reviews of admissions to determine medical necessity for admission, observation and continued stays. Refers those that do not meet criteria to the Medical Director, Case Management.
Performs concurrent reviews for the appropriateness of resource consumption and refers any over or under utilization to the Medical Director, Case Management.
Reviews specific incidents and utilization problems with Physician Advisor such as extended hospital stays, complications with care, and patients waiting for placement.
Participates in Medical Staff department meetings and review teams, as appropriate, in order to provide input regarding incidents, prolonged hospital stays, delays in treatment, quality issues or discharge disposition problems.
Communicates with physicians as patient's condition warrants, evaluates the physical status and psychosocial adaptation to hospital environment, monitors variances from the Critical Path/Care Plan and collaborates with other members of the health care team to ensure appropriate interventions are implemented.
Conducts ongoing utilization review for compliance with approved third-party treatment plan and ensures necessary interventions. Communicates with payor's regarding clinical updates and the need for continued hospitalization.
Identifies high-risk patient and non-patient situations and facilitates problem-solving process with interdisciplinary team as needed.
Assesses each patient on admission for discharge planning and educational needs, plans the patient's care and ensures that patient family teaching is complete.
Upholds the Code of Ethics and Corporate Compliance.
Adheres to and helps to enforce all compliance policies relevant to his/her area.
Assures timely compliance education as requested by the Compliance Officer and/or through corporate initiatives.
MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
EDUCATION & TRAINING:
Technical, critical thinking and interpersonal skills relevant to clinical area in order to effectively communicate with patients and physicians.
Ability to speak clearly enabling patients and the like easy comprehension.
Ability to write and print legibly.
Demonstration of customer focused skills.
New England Sinai Hospital And Rehabilitation Center