Acute Care Case Manager - RN / Social Worker FT Day Shift Job Opening

Description:
Job Summary:
Case management serves to coordinate patient care during the hospitalization process and the transition of care with return to the community, through a collaborative approach along with the interdisciplinary care team, advocating for the patient to ensure each individual patients needs are met throughout the continuum of care. Utilizes all elements of Case Management Society of America’s (CMSA) role functions.

Qualifications:

• Self-starter; able to work independently and manage caseloads with minimal direction.
• Excellent interpersonal, verbal communication, problem-solving, and organizational skills.
• Able to build and maintain relationships with patients, staff, providers, outside agencies, and community resources.
• Outstanding clinical and assessment skills.
• Able to coach/educate patient and caregiver in a culturally acceptable manner.

General Responsibilities:

• Upholds the organizations' Mission, Values and Goals by adhering to the NHS Standards of Performance.
• Participates in team-based patient-centered care delivery.
• Completes case management interviews and assessments while coordinating utilization of healthcare resources.
• Reviews admitting clinical/social information to determine a discharge plan utilizing a holistic patient approach. Makes appropriate referrals to resources and services as needed (SNF, Homecare, etc.).
• Performs clinical assessments, care planning, community outreach, and service referrals with appropriate EHR documentation.
• Identifies and develops a discharge plan of care utilizing a multidisciplinary team based approach. Implements and evaluates care plans according to case management eligible criteria and patient needs throughput the continuum of care.
• Manages assigned case load in an efficient and effective manner.
• Functions as a resource to patients/families/providers/agencies/insurance companies/liaisons.
• Identifies barriers to care; participating in development and implementation of strategies to remove or reduce barriers and promote resolution through coordination and problem solving process.
• Attends hospital interdisciplinary rounds to develop appropriate plan of care for each patient.
• Assists in coordination of care across the entity while transitioning patient and families in the community with appropriate resources and support.
• Implements discharge plan offering patient choice for a safe and effective discharge.
• Collaborates with healthcare providers, transitional and embedded office care coordinators, and outside agencies to assist in transitions of care.
• Monitors inpatient days and utilization. Communicating all delays and barriers to the appropriate team members for review and intervention.
• Follows the Medicare guidelines standards to qualify patient's admission status for appropriateness inpatient, observation and extended recovery.
• Reviews provider documentation/orders to ensure Medicare regulations and standard requirements have been met during hospital admission.
• Issues the appropriate letter of non-coverage, explaining the process for appeals, facilitates requested, and financial liability to patients when applicable.
• Participates in the denial management process, including the appeal process, tracking and collection of data.
• Performs responsibilities in a respectful, professional, and ethical manner at all times.
• Able to navigate in multiple healthcare database systems (EHR/Insurance)
• Actively participates in various community and multi-department committees to assure effective continuum of care and up to date community resource knowledge.
• Serves on various NHS Committees and other NHS projects as assigned.
• Maintains up to date knowledge on case management, utilization management, discharge planning per government and insurance guidelines and regulations.
• Demonstrates a thorough knowledge of his/her key responsibilities.
• Performs all other duties as assigned by director and/or senior leadership.

Requirements:

• Minimum of 2 years of acute care experience or Case Management experience. Utilization experience preferred.
• Knowledge of healthcare finances, regulatory agencies, and clinical guidelines preferred.
• Experience with electronic health record is strongly preferred
• Outpatient or home health experience is beneficial
• Current licensure to practice in the State of Delaware and/or Compact State as a Registered Nurse (RN) (BSN preferred) or Licensed Social Worker (LCSW) / Master’s Social Work (MSW) /Bachelor’s Social Work (BSW). LPN may be considered.
• Current CPR certification required
• Must meet all applicable federal, state, and local professional requirements