Inpatient Case Manager

Description

We are currently looking for aFull Time Inpatient Case Managerto join our Inpatient Case Management and Social Worker Team team located at the Chickasaw Nation Medical Center working8:00AM-5:00PM - Mo Tu We Th Fr.

Provides comprehensive nursing care and care coordination, including patient education, clinical support, case management, and utilization review activities to support appropriate resource use and patient care. Collaborates with providers and interdisciplinary teams to optimize workflows, improve outcomes, and support organizational performance initiatives in compliance with regulatory standards.

• Oversees daily management of care coordination for Native American patients by assessing, planning, and organizing health care services within a framework of established guideline/protocols, health status of patients, and available funds/resources
• Generates and faxes/copies patient protected health information necessary for continuum of care to outside healthcare facilities and/or providers, ensuring that all records needed for this process are accurate and valid, while maintaining patient confidentiality, security and integrity of data and information in accordance with HIPAA and the Minimum Necessary Rule, and noting within the patient’s EHR each disclosure according to CNDH documentation policy
• Develops and implements care within the CNDH to ensure continuity of care, decrease fragmentation of services, and enhance health promotion disease prevention activities
• Identifies and screens cases, determines the availability of community resources, evaluates that status of the patient’s mental and physical capabilities and provides coordination
• Uses computer system and medical record to conduct admission and continued stay reviews
• Ensures documentation of appropriate level of care
• Documents in the medical record for the purpose of treatment and referral options
• Shares clinical information with providers and other health care professionals
• Monitors patients assigned to 23-hour observation status and when necessary, communicates with hospital staff and/or attending physician
• Monitors admission, screens referrals, performs interviews, and interventions
• Serves as a resource to identify all possible patient resources and potential payer sources
• Works with the family to identify possible alternate funding such as Medicare, Medicaid, veteran’s health benefits, disability, vocational rehabilitation, or tribal programs/services
• Serves as a resource for nurses, providers, and the patient/family during the care coordination process and discharge planning
• Facilitates referrals to outside agencies such as home health agencies, need for durable medical equipment (DME), hospice, nursing homes, long term care, etc
• Assists social work services with discharge planning and clinical interpretations as needed
• Establishes a working relationship with other IHS providers and hospitals; external providers and hospitals; tribal health programs providers and hospitals; home health agencies; community outreach programs; and customers of the Chickasaw Nation Department of Health
• Tracks potentially avoidable days for reporting to the Discharge Planning Committee
• Consults with the physician advisor when indicated by review results
• Works closely with hospitalist and supporting staff to make appropriate referrals for continued follow-up and care following discharge from the acute care setting
• Ensures that case management activities are ethical and of value to the patient, their family, and the providers of care both within and outside the health system
• Maintains case management review forms on all new admissions and concurrent reviews
• Participates in multidisciplinary discharge planning meetings, reporting on potential avoidable days, and emphasizing the team approach in care and subsequent discharge of patients
• Develops and implements methodology of securing, retrieving, gathering and analyzing data relative to internal and external health care provision, as it related to utilization management, quality improvement, and case management
• Conducts chart audits in an effort to demonstrate health system performance…