Atlantic Health System, is seeking a Full-time Inpatient Care Manager for the Care Management Department at Morristown Medical Center to work 8am-4pm.
Patient Assessment: All patients are assessed within one business day of admission for appropriateness of admission, level of care & discharge needs. Initial assessment will identify patients support system, discharge barriers, prior level of functioning, previous admissions, community use of services, home care, durable medical equipment, etc. & confirms demographics & payer source. Develops an anticipated discharge plan. Identifies & initiates referrals for other services as indicated: social work, physical therapy, financial counseling etc. Reassesses for changes in patients condition or patient/family circumstances to amend discharge plan & identify patients medical readiness for discharge. Communicates & documents discharge plan with interdisciplinary team.
Utilization Management/Level of Care: Applies appropriate guidelines for all initial & concurrent review s to determine LOC. Documents all review s using SI, IS format. For all LOC determinations that are inappropriate for inpatient CM actively confers with attending and refers to PA in a timely manner. Gives thorough admission & continued stay review s and faxes to appropriate payer via Allscripts in a timely manner. Demonstrates know ledge & follow s Medicare requirements, including initiating IM letter at admission, discharge & appeal follow -up. Concurrently identifies days at risk for denial or low er level of care & proactively initiates strategies to gain acute inpatient authorization. Documents delays in the Allscripts system. Identifies system problems impacting patient care/progress & initiates resolution to help reduce length of stay. Demonstrates comprehensive know ledge of Medicare criteria for both inpatient and outpatient status utilizing Milliman Care Guidelines. Educates patients, families and physicians regarding LOC Milliman guidelines and LOC status.
Discharge Planning: Assesses patient within one business day of admission and takes a proactive approach in anticipating and facilitating their discharge needs ie: ordering wound vacs, ordering DME/O2, arranging VNA or infusion, etc. Communicates general benefit information to patients/families regarding coverage. Initiates, coordinates& ensures the discharge plan is moving forward. Obtains authorizations. Communicates the initial discharge plan to the patient, family, physician, & team members to ensure agreement. Attends family meetings as necessary. Identifies actual & potential issues w ith the discharge plan & develops strategies to resolve these issues. Collaborates & communicates w ith external case managers in a timely manner to initiate discharge plan. Communicates/educates patients & families regarding length of stay, discharge process, & available resources. Negotiates w ith payers regarding options for the continuing or alternate care plan based on medical necessity. Collaborates with Social Services for patients requiring complex discharge plans.
Communication/Documentation: Ensures discharge plan consensus with patient/family, physician & payer & documents. Collaborates & communicates with external care/case managers in a timely manner to obtain authorizations. Ensures that all CM documentation is complete in Allscripts & the Medical Record including initial/ transfer assessment w ithin one business day of admission/transfer as w ell as ongoing assessments. re:patient and family encounters. Participates in daily & long stay rounds & coordinates follow -ups to resolve issues. Participates in family meeting. Responds to phone calls/emails in a timely manner . Consistently uses SBAR communication as either the receiving or sending Care Manager by providing additional information & completing Universal Transfer Form in Medical Record. Completes all documents as required by hospital policy including IPOC & Patient Education Forms, Pathway/Guidelines as needed
High school/GED required
1 year acute care hospital experience preferred
Previous care management experience preferred
Current NJ Registered Nurse License
CCM or ACM preferred
Atlantic Health System aims to deliver the highest quality, safety and care combined the best experience for our patients and their families. We are confident that you will find success within Atlantic Health System, which has been named for the 14th year in a row to Fortune's 'Top 100 Best U.S. Companies to Work For' list. We believe you will find that our culture of collaboration and care exemplifies the value we place on our patients, their families and our employees.
Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.
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