South Peninsula Hospital
Receive alerts when this company posts new jobs.
CASE MANAGER (PCN1035)
at South Peninsula Hospital
Work Hours: Days
Reporting to the CNO, this position will support SPH mission and vision by providing leadership for Social workers and care management over sight for inpatients and residents in the LTC unit. This position will be a partnership with leadership to provide support on patient management concerns. Conducts investigations of Patient care related issues and provides guidance on financial, and service line programs to enhance the patient’s care. This position provides support to inpatient clinical units, managers and social workers in the patient care areas including residents in the long term care unit.
NATURE AND SCOPE:
The manager of case management is responsible and accountable for the implementation of the case management program at the hospital level. The components/roles of the inpatient case management program consist of the following: care facilitation, utilization management, case management and discharge planning. This position is an exempt position under the laws of the FLSA. This position reports to the CNO.
QUALIFICATIONS / REQUIREMENTS:
- Working knowledge of payer requirements and discharge planning regulations that support the effect for the development of departmental policies, procedures and standards.
- Working knowledge of Medicare, managed care, inpatient, outpatient and home health continuum, as well as utilization management, discharge planning and case management.
- Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
- Working knowledge of concepts of associated with performance improvement.
- Self-motivated, proven communication skills, assertive, able to work independently and as a team member.
- Demonstrated effective working relationships with physicians.
• Graduate of an accredited program of Registered Nursing.
• Diploma in Nursing with 2-3 years management experience is minimum requirement. Bachelor of Science in Nursing degree preferred.
• Minimum of two years of Case Management experience in utilization management, case management, discharge planning or other cost/quality management program.
• Two to three years previous management experience is preferred with minimum of two years’ experience in hospital- based nursing.
• Current RN license
- Provide leadership, education and supervision for the day-to-day workflow of Case Managers and Social Workers.
- Monitor Case Management Department’s documentation to ensure meets regulatory compliance.
- Collaborate with Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data (e.g. Avoidable Days, Readmissions).
- Maintain skills in case management and utilization review to allow for appropriate management of patients using all resources that are available to the patient.
- Work closely with the acute care leadership, emergency room and OB coordinator to ensure that all discharges and placements are appropriate and ensure discharge plans are in place.
- Communicate with physicians concerning patient needs and aid with development of appropriate plan of treatment and assist with level of care and bed placement assignments.
- Directly responsible for personnel actions including hiring, performance appraisals, employee schedules, and maintain payroll records and time reports.
- Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care.
- Case Manager will be responsible for all discharge planning. Provides necessary education and resources to meet the discharge needs of individual patients and families.
- Active participant of care conferences and individual family conferences.
- Promote efficient utilization of clinical resources.
- Promotes the appropriate amount of resources are used based on patient acuity.
- Assures appropriate level of understanding, awareness and compliance with all applicable CMS, state and local agency laws, internal/external regulations, guidelines, policies, procedures and professional standards.
- Other duties as assigned.