Case Manager; Maternal Child

Position: Case Manager (Maternal Child)
# Case Manager (Maternal Child)

Requisition :
189154

Department:
200769 Hospital Care Management

Schedule:

Full Time - Eligible for Benefits

Shift:
Day Category:
Nursing Apply Now## Position PurposeA clinical position that works within a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options of care, services and alternative levels of care to meet an individual’s needs and facilitate appropriate discharge and length of stay. By assuming a leadership role with the interdisciplinary team, the Case Manager promotes appropriate utilization of care and services, and cost effective outcomes.

The Case Manager is responsible for the review of the medical record to ensure care and services are delivered timely and appropriately. This position is responsible to reduce and/or eliminate avoidable days.## Nature and Scope This position has the responsibility to promote case management activities through the health continuum. Case Management starts in the pre-acute phase and continues through the healthcare continuum.

Case management begins with the assessment of premorbid health status, current medical condition and post-acute needs. The Case Manager also fulfills Utilization Management responsibilities, including initial UR assessment within 24 hours of admission and concurrent continued stay reviews, ensuring that services are being delivered at the most appropriate level of care to meet the client’s needs and to secure reimbursement from payers.

Utilizing an interdisciplinary team approach, this position acts as a consultant and educator on matters referring to alternative levels of care and managed care issues. Through collaboration, case managers provide optimal patient care through, assessment, planning, implementation, and evaluation of neonatal, pediatric, adolescent, adult, and geriatric patients and families . This position also provides information such as certified LOS and reimbursement issues to physicians as needed to ensure the appropriate and timely disposition of the client to the next level of care.

The Case Manager monitors and documents the progress of the plan, making revisions as needed, to assure a smooth transition to the next level of care at the time of discharge.

Specifics of Position:
• Excellent documentation and communication skills and must be able to use critical thinking, find solutions quickly and be comfortable escalating when services or care are not delivered efficiently or appropriately.
• Initial assessment on patients with a CM Consult within 24 hours of admission to include identification of anticipated post-acute needs and potential barriers.
• Participate in IDDRs presenting GMLOS, ALOS, anticipated discharge plan, and discharge barriers
• Drive progression of care utilizing evidence based clinical guidelines (i.e., Inter Qual)
• Facilitate a discharge plan based on clinical needs and resources (e.g., wound vac)
• Ensures post-acute referrals are entered in EMR
• Discharge plan is in place and documented in EMR
• Choice forms are obtained as needed
• IMMs are signed 48 hours prior to DC
• Ensures all are in agreement with discharge plan, date of discharge, and plan for care transitions
• Reviews EMR and ensures when appropriate:
• DME orders entered and Face to Face documentation (as applicable) is done
• DC summaries are written and in system in time for discharge
• All tests are scheduled timely and escalate as needed (Lab, Imaging, Surgery)
• LOS does not extend beyond calculated GMLOS and ensure everyone on care team is working towards timely discharge.
• Clinically complex cases are worked up appropriately for discharge needs (wound vac, IV meds, Meds Requiring Pre Approval, etc.)
• Incumbent must respect beliefs and values while…