Description:

Must come from a hospital setting. Home health, hospice or health plan case management will not be considered

Inpatient: 8:30-5PM M-F, rotating weekends (could be every other weekend, just dependent on staffing needs)

They are making discharge plans, helping with the care plan with the doctors, less busy than ED.

• Plans, develops, assesses & evaluates care provided to members.

• Collaborates with physicians, other members of the multidisciplinary health care team & patient/family in the development, implementation & documentation of appropriate, individualized plans of care to ensure continuity, quality & appropriate resource use.

• Recommends alternative levels of care & ensures compliance with federal, state & local requirements.

• Assesses high risk patients in need of post-hospital care planning.

• Develops & coordinates the implementation of a discharge plan to meet patient's identified needs.

• Communicates the plan to physicians, patient, family/caregivers, staff & appropriate community agencies.

• Reviews, monitors, evaluates & coordinates the patient's hospital stay to assure that all appropriate & essential services are delivered timely & efficiently.

• Participates in the Bed Huddles & carries out recommendations congruent with the patient's needs.

• Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, & obtaining all authorizations/approvals as needed for outside services for patients/families.

• Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient & non-KFH facilities.

• Acts as a liaison between in-patient facility & referral facilities/agencies & provides case management to patients referred.

• Refers patients to community resources to meet post hospital needs.

• Coordinates transfer of patients to appropriate facilities; maintains & provides required documentation.

• Adheres to internal & external regulatory & accreditation requirements & compliance guidelines

including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA & DOL.

• Educates members of the healthcare team concerning their roles & responsibilities in the discharge

planning process & appropriate use of resources.

• Provides patients with education to assist with their discharge & help them cope with psychological

problems related to acute & chronic illness.

• Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or

patient safety which are identified during case review or other activities.

• Reviews, analyses & identifies utilization patterns & trends, problems or inappropriate utilization of resources & participates in the collection & analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.

• Coordinates, participates & or facilitates care planning rounds & patient family conferences as needed.

• Participates in committees, teams or other work projects/duties as assigned.

Skills:

Case management, Acute care, discharge planning

Top Skills Details:

Case management,Acute care,discharge planning

Additional Skills & Qualifications:

1 full year of acute case management experience needed recently

RN license required

BLS from American Health Association required

Experience Level:

Intermediate Level

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