Location: all cities,NY, USA
Job Description
Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses, plans, oversees and evaluates the appropriateness of care throughout admission andhospitalization of the patient.
Job Responsibility
* * Facilitates patient management throughout hospitalization.
* Participates in patient management rounds and patient centered meetings.
* Identifies potential delays and resolves issues with appropriate departments.
* Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.
* Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.
* * Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.
* Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues.
* Works with on-site screeners in transitioning patients to appropriate post discharge settings.
* Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits.
* Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.
* Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.
* * Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan.
* Involves patient and/or family in discussion and planning for anticipated need for care following discharge.
* Ensures patient and/or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards.
* * Performs concurrent utilization management using Interqual criteria.
* Conducts chart review for appropriateness of admission and continued length of stay.
* Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.
* Ensures compliance with current state, federal, and third party payer regulations.
* Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.
* Communicates with insurance companies and physicians regarding utilization issues.
* Utilizes important message from Medicare (IMM) when appropriate.
* Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs.
* * Participates in the quality management of patient care outcomes.
* Submits data to management regarding case management and/or quality initiatives.
* Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days.
* * Initiates appropriate discharge planning as supported by initial assessment at time of admission
* Reviews patient's chart.
* Assesses each patient physically, psychosocially and financially.
* Assesses patient's support system to facilitate appropriate discharge to community.
* Substantiates, with the physician, the need for home care services.
* Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge.
* Arranges for post-hospital transportation, when indicated.
* Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge.
* * Documents the case management process in the medical record.
* Completes and documents a psychosocial assessment on the patient.
* Documents on-going processes of patients' hospitalization.
* Documents finalized discharge plan and disposition.
* Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.
* Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient.
* Ensures case management sheet is current and accurate.
* * Performs related duties, as required.
* ADA Essential Functions
Job Qualification
* Bachelor's Degree in Nursing, required.
* Current license to practice as a Registered Professional Nurse in New York State.
* Case Management Certification, preferred.
* Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred.
* Keeps abreast of developments in the field and serves as a resource to other staff.
Additional site-specific qualifications may apply
* Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).