Case Manager

Job Details:

Job Location:

Caldwell Medical Center - PRINCETON, KY, Salary Range:
Undisclosed, CALDWELL MEDICAL CENTER

JOB DESCRIPTION

JOB TITLE:

Case Manager (Transitional Care, Utilization Review, Discharge Planner, Social Services) DEPARTMENT:
Case Management

REPORTS TO:

Med/Surg Manager SUPERVISES:
Activities Therapist/COTA

Position Summary:

The Transitional Care component of this job is responsible for evaluating patients for admission to the Swing Bed Program and ongoing utilization review of Swing Bed patients.

• Demonstrates professional development/clinical competency; assists in the training and education of personnel
• Interacts as a liaison person with the Medical Staff, Therapies, Chief Nursing Officer, Nursing Department and all other departments regarding the long-term care patient and the coordination of care.
• Participates in multidisciplinary planning including the discharge process.
• Acts as an advocate for the patient.
• Actively seeks patients that would benefit from Transitional Care services. The Utilization Review component involves performing admission and continued stay reviews on all patients and reporting to utilization management agencies (as required) using approved criteria for effective evaluation of the need for hospital level of care and appropriate use of hospital resources.
• Performs pre-admission reviews and consults with physician concerning patient stays
• Utilizes patient care guideline software to determine appropriate patient status
• Interacts with the Business Office and the CFO in regards to payment issues involving patients. The Discharge Planner component involves working with the patient, their family, the provider, and other departments and/or outside agencies to facilitate a smooth and safe transition from hospital/transitional care to home.
• Works with patient and family to develop plan for transition to home
• Facilitates follow-up appointment.
• Works with Therapy and Nursing to arrange for receiving home care or DME needs. The Social Services component involves providing support to patients and family members during times of crisis as well as acting as liaison between the various healthcare disciplines and the patient and/or patient’s family
• Intervenes in situations where patients and/or their families have complaints or concerns
• Works with others to resolve these issues in a positive manner. POSITION RESPONSIBILITIES ESSENTAIL FUNCTIONS:
• Responsible for the effective and efficient operation of the Transitional Care program ensuring that the organizational and departmental objectives are being met.
• Conduct on-site reviews of potential Transitional Care referrals whenever possible.
• Builds and maintains a strong working relationship with the physicians.
• Acts as a resource to the physicians. Uses recognized/appropriate patient care guidelines to assist with care decisions being made by the physician. Teaches others (Physicians and Nursing) how to access and utilize the patient care guidelines.
• Acts as a resource to the ED physicians and ED staff in determining appropriate patient status (inpatient; observation; etc) for those patients being hospitalized from ED.
• Builds and maintains strong working relationships with peers from other facilities. Collaborates to achieve and maintain a high swing bed referral rate. Uses these opportunities to promote PR for our organization and the services we offer.
• Document UR/Case Management activities such as precertification, concurrent and retrospective reviews on all patients.
• Assess patient and family needs by reviewing the admission assessment including history and physical and ongoing assessments including safety, infection control, and health education needs.
• Utilizes documentation skills to accurately complete patient/unit forms and records.
• Intervenes as appropriate in mental and/or physical patient crisis situations. (i.e. patient falls, combative behavior, etc.)
• Consults regularly with other staff and physicians to review treatment plans when level of clinical care requires further clarification.
• Assists with training and orienting of new departmental staff as needed. Ensures that new staff members receive adequate instruction/training when assigned to the department.
• Acts as a resource person to the unit staff and provides appropriate and timely feedback concerning their performance.
• Works cooperatively with others. Has respect for and an understanding of the contributions of all team members.
• Assists in maintaining established departmental policies and procedures,…