Case Manager - Care Coordinator Union, Non-Exempt

Overview

The purpose of the Case Manager position is to support the physician and interdisciplinary team in the provision of patient care, with the objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions.

The Case Manager is accountable for a designated patient caseload and plans effectively to meet patient needs, manage length of stay, and promote efficient utilization of resources.

• Actively participates in clinical performance improvement activities.
• Applies approved Inter Qual criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.
• Assists in the compilation of physician profile data regarding LOS, resource utilization, denied days, cost, case mix index, patient satisfaction, and quality indicators.
• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
• Collaborates and communicates with the multidisciplinary team in all phases of the discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Facilitates care for a designated caseload with the physician and multidisciplinary team; monitors progress and intervenes to ensure a patient-focused, high-quality, efficient, and cost-effective plan of care; coordinates completion and reporting of diagnostic testing, treatment plan and discharge plan, plan modifications as needed, communication to third-party payers, assignment of appropriate levels of care, and documentation in appropriate systems and records.
• Collaborates/communicates with external case managers; collects delay-in-service data and data for performance and outcome indicators as determined by the director.
• Communicates with Financial Counselor to facilitate covered-day reimbursement certification for assigned patients.
• Discusses payer criteria and issues with clinical staff on a case-by-case basis and follows up to resolve problems with payers as needed.
• Completes utilization management for assigned patients; coordinates/facilitates patient care progression throughout the continuum.
• Documents relevant discharge planning information in the Affinity GUI System according to department standards.
• Ensures that all elements critical to the plan of care are communicated to the patient/family and care team and documented to ensure continuity of care.
• Ensures/maintains plan consensus from patient/family, physician, and payer; facilitates transfer to other facilities.
• Identifies at-risk populations using approved screening tools and follows established reporting procedures.
• Initiates and facilitates referrals to the Home Health Liaison for home health care, hospice, and medical equipment and supplies.
• Issues Notices of Non-coverage per hospital policy.
• Manages all aspects of discharge planning for assigned patients and meets directly with patient/family to assess needs and develop an individualized plan in collaboration with the physician.
• Monitors all transfer DRGs and monitors length of stay and ancillary resource use; takes actions to achieve continuous improvement in both areas.
• Performs 100% UR Review on all Medicare One-Day admissions; proactively identifies and resolves delays and obstacles to discharge.
• Refers appropriate cases for social work intervention based on department criteria; refers cases and issues to physician advisor in compliance with department procedures and follows up as indicated.
• Seeks consultation from appropriate disciplines/departments to expedite care and facilitate discharge.
• Uses data to drive decisions and plan/implement performance improvement strategies related to assigned patients, including fiscal, clinical, and patient satisfaction data.
• Uses quality screens to identify potential issues and forwards information to the PI department; utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely, appropriate patient management.

Pay Transparency
The hourly rate range for this position is $46.00 - $76.07. When extending an offer of employment, the University of Southern California Arcadia Hospital considers factors such as, but not limited to, the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual…