Crisp Regional Health Services Job - 41625116 | CareerArc
  Search for More Jobs
Get alerts for jobs like this Get jobs like this tweeted to you
Company: Crisp Regional Health Services
Location: Cordele, GA
Career Level: Mid-Senior Level
Industries: Hospitals, Health Care

Description

Position Summary:

Under the leadership of the Manager, Utilization Review, the Case Manager is an active member of the Utilization Review team that delivers professional services consistent with the strategic vision, goals, philosophy and direction of the Utilization Review Department and CRHS. The Case Manager provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The Case Manager enhances the quality of patient management and satisfaction, promotes the continuity and cost effectiveness of care through integrating the functions of case management, utilization review and management and discharge planning. The Case Manager is accountable for the care, coordination and discharge planning of all patients.

 

Basic Qualifications:

  • Education:

Requires a Bachelor's or Associates degree in Nursing or a Bachelor degree in Social Work.

  • Experience:

Requires two or more years of work-related experience or any equivalent combination of education, training and experience.

  • Licensure, Registration & Certification

Requires and maintains current state license as a Registered Nurse or as a licensed Social Worker. A Certified Case Manager certification is preferred. Requires a current certification in BLS (if BLS certification is not current upon hire, it must be obtained within three (3) months of hire).

 

Essential Job Responsibilities:

  • Coordinates the integration of social services/case management functions into the patient care, discharge and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
  • Conducts concurrent medical record reviews using specific indicators and criteria as approved by medical staff, JCAHO, CMS, and other state agencies.
  • Acts as patient advocate investigating and reporting adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
  • Promotes the effective and efficient utilization of clinical resources.
  • Ensures that patient tests are appropriate and necessary and are carried out within the established timeframe and results are promptly available.
  • Conducts reviews for appropriate utilization of services from admission through discharge. Evaluates patient satisfaction and quality of care provided.
  • Initiates and presents “denial letters” when appropriate.
  • Assesses patient care required throughout continuum of care for diagnosis, procedures and DRG's.
  • Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians in maintaining appropriate cost, case, and desired patient outcomes.
  • Explains the clinical case manager role and process to patients and their families, completes expanded medical and psychosocial assessment of their needs at time of admission.
  • Monitors and assesses patient's progress through expected hospital stay.
  • Refers to Discharge Planner or Social Worker cases where patients and/or family would benefit from counseling required to complete complex discharge plan.
  • Serves as a patient advocate encouraging a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
  • Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identify post-hospital needs.
  • Directs and participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling patient needs or special cases.
  • Coordinates the provision of social services to patients, families and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.
  • Mentors new employees as requested.
  • Completes all required professional education including continuing nursing/social worker education hours and mandatory in-services to maintain professional licensure.
  • Performs other related job duties as assigned.

 

Standards of Performance:

  • Coordinates the integration of social services/case management functions into the patient care, discharge and home planning processes.
  • Conducts concurrent medical record reviews using specific indicators and criteria as approved by CRHS, medical staff, JCAHO, and other state or federal regulatory agencies.
  • Acts as a patient advocate by investigating and reporting adverse occurrences. Performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
  • Promotes the effective and efficient utilization of clinical resources.
  • Develops patient care plan and sets mutual goals with the patient as measured by chart audits and observation.
  • Participates in performance improvement activities and chart audits as measured by documentation and submission of PI data as assigned.
  • Demonstrates positive interpersonal skills when communicating with patients, families, coworkers and physicians, as measured by observation, and through patient and family satisfaction survey results.
  • Participates in education as required through mandatory department in-services, acquisition of continuing nursing/social work education, as measured by education, attendance records and maintenance of professional licensure.
  • Demonstrates adherence to CRHS Standards of Behavior as measured by peer, supervisor and patient observations.
  • Demonstrates reliability as measured by compliance with CRHS Time and Attendance policies.
  • Demonstrates professional conduct by maintaining strict confidentiality, as measured by valid complaints given to the supervisor or director.
  • Demonstrates adherence with infection control procedures as measured through direct observation.


 Apply on company website