The case manager facilitates progression-of-care; and monitors the patient's progress to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective.
A Bachelor's degree in a clinical healthcare discipline such as nursing, medicine, social work, respiratory or physical therapy, or other related allied health field.Comparable experience will be considered in lieu of a bachelor's degree.
If Registered Nurse, must be licensed to practice in Michigan. Also, for those hired into this job after January 1, 2015, it is required to obtain a BSN within 5 years of start date.
Must have recent patient care experience and knowledge of hospital operations
Knowledge of Case Management Society of America's case management standards of practice.Eligible to sit for, and successfully pass, the test for certification as a Certified Case Manager (CCM) or Accredited Case Manager (ACM) within 2 years of employment.
The Case Manager must possess strong communication and interpersonal skills, leadership, negotiation skills, good leadership talent.
General knowledge of the payer industry, resource management, reimbursement, and evidence based clinical practice is essential.
Reports to the Manager of Case Management.
AGE OF PATIENTS POPULATIONS SERVED
Cares for patients in the age category(s) checked below:
1.Supports the Mission, Vision and Values of Munson Healthcare
2.Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
3.Promotes personal and patient safety.
4.Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
5.Uses effective customer service/interpersonal skills at all times.
6.Timely response to screening referrals for case management services
7.Confirm admission diagnosis and identify related quality/care metrics to promote medical compliance.
8.Advocate for patient by assessing that patients healthcare needs are being addressed in the most appropriate level of care.
9.Encourages and facilitates patient/family participation in all care and treatment decisions.
10.Educates members of the patient's healthcare team on the appropriate access to, and use of various levels of care.
11.Identifies patients at risk for readmission and refers them for community based follow up.
12.Recognizes and responds appropriately to readmission or psychosocial risk factors.
13.Consults with physician advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels.
14.Serves as primary liaison between and among physicians, patients, families, payers, external case managers and interdisciplinary clinical team.
15.Collaborates with Post-Acute Coordinators to monitor and facilitate the progress of completing complex post-acute services
16.Interface with utilization review specialists to stay current on patient's eligibility for admission, continuing stay or readiness for discharge according to InterQual® criteria.
17.Persevere in attempts to influence clinical and financial outcomes of care.
18.Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes.
19.Assertively manage resource utilization while appropriately navigating the patient's movement along the continuum of care.
20.Collaborate with social workers, counselors and Resource Center coordinators to research discharge placement options, when home discharge is not possible, while continuing to focus on patient/family goals, interdisciplinary team recommendations, available payer benefits and private financial considerations which may impact placement.
21.Utilizes the Program Manager, Director and Medical Advisor as expert advisors to gain insights in dealing with physicians and Resource Management issues.
22.Works with resource center and providers to determine patient's eligibility for post-acute services