AMVETS Jobs

This job was posted by https://www.azjobconnection.gov : For more information, please see: https://www.azjobconnection.gov/jobs/6987541

Summary:

The Case Manager II supports the physician and interdisciplinary team in the provision of patient care, with the underlying 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. This role integrates and coordinates utilization management, care facilitation, and discharge planning functions.

Responsibilities:

Coordinates/Facilitates patient care progression throughout the continuum; Works collaboratively and maintains active communication with physicians, nursing, and other members of the multi-disciplinary care team to effect timely, appropriate patient management; Ensures appropriate clinical pathway assignments by staff nurses; Address and resolves system problems impeding diagnostics, treatment progress, and obstacles to discharge; Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge; Utilizes advance conflict resolution skills as necessary to ensure timely resolution of issues; Collaborates with the physician and all members of the multi-disciplinary team to facilitate care for designated caseload, monitors the patients progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on timely basis: Completion and reporting of diagnostic testing, discharge plan, modification of place of care, communication to third-party payers, assignment of appropriate levels of care , and documentation in TQ screens and patient records.

Collaborates with medical, nursing and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting

Completes utilization management and quality screening for assigned patients; Applies approved utilization acuity criteria to monitor appropriateness of admissions and continue stays and documents findings based on department standards; Identifies at-risk populations using approved screening tool and follows established reporting procedures; Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas; Refers cases and issues to physician advisor in compliance with department procedures and follow ups as indicated.

Ensures that all elements critical to the plan of care and clinical path have been communicated to the patient/family and members of the health care team and are documented as necessary to ensure continuity of care.

Manages all aspects of discharge planning for assigned patients; Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with the physician; Collaborates and communicates with external case managers and multidisciplinary team in all phases of discharge planning process, including initial patient assessment within 48 hours, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation; Ensures/maintains plan consensus from patient/family, physician and payer; Refers appropriate cases for social work intervention based on department criteria; Initiates and facilitates referrals through the resource center for home health care, hospice, and medical equipment and supplies; Documents relevant discharge planning information in the medical record according to department standards; Facilitates transfers to other facilities.

Participates actively in clinical performance improvement activities and 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.

Uses data to drive decision and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical, and patient satisfaction data.

Other duties as assigned