To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Functions as a member of the Case Management/SW health care team, responsible and accountable for ensuring appropriate transition of care from initial point of contact through discharge. This staff member is responsible to proactively plan and develop solutions to unique and complex discharge processes in collaboration with the Case Management staff and health care team. Interaction with both external vendors, insurance companies, all members of the interdisciplinary health care team & the patient/responsible party are primary to the functioning of this position. The action of these staff members directly impacts the ability to discharge patients in a timely and safe manner which impacts the hospital LOS and the delivery of quality patient care.
- 1. Establishes relationships with members of interdisciplinary health care team, patients/families in order to gather necessary information which facilitates the acquisition of appropriate discharge resources. Provides information about expectations for service, directs patients and families to appropriate sources to understand certifications & safety of home care, SNF, LTAC, IRU, etc. Provides quality rating information per request.
- 2. Is responsible for obtaining appropriate levels of pre-authorization from insurers to ensure timely discharge to appropriate skilled nursing facilities.
- 3. Maintains competency in Medicare/Medicaid regulations and is able to understand, interpret and educate on insurance company rules and limitations to patient & families. Offers patient/family choice of facility, home care provider, vendor. Follows hospital corporate compliance guidelines to avoid case finding by agencies or enticements for referrals from hospital staff.
- 4. Coordinates flow of communication of PHI under HIPAA guidelines to the appropriate healthcare provider or vendor. Assures all necessary information is documented and communicated to members of the healthcare team, and then is transferred to the next provider in a timely manner. Delegates to staff to ensure completion of their duties, which facilitates timely discharge. Ensures compliance with all regulatory requirements for the appropriate screening of patients for skilled nursing facilities. Reviews patient information to provide communication to healthcare team.
- 5. Provides approved ASCEND, insurance authorization to accepting facility. Collaborates with home care staff and insurance personnel to facilitate and approve timely and appropriate discharge processes.
- 6. Maintains current and future knowledge base of all vendors? array of services and provides patient/representative with information. Interacts with outside vendors in the maintenance of relationships, remaining cognizant of HIPAA regulations.
- 7. Utilizes all electronic computer systems to aid in workflow. Utilizes Care Management Navigator to document referral activity, communication with vendors and placement process.
- 8. Able to independently assess the patient and family discharge needs and then facilitate consultation with SW, Financial Counselors, Patient Access, and Patient Relations; identifies potential patient complaint areas and resolves issues with appropriate parties. Refers issues for resolution to members of the health care team and/or Patient Relations as appropriate for service recovery. Maintains awareness of scope of role and consults with the appropriate staff to accomplish resolution of any issues.
- 9. Guides families to initiate and follow through on all Medicaid applications and insurance validation.
- 10. Actively participates in all Care Management activities including staff meetings, continued education and ongoing workflow and process improvement initiatives. Demonstrates patient service excellence at all times.
- 11. Must be able to ensure appropriate communication across the care continuum and provide timely resolution to issues as they arise.
- 12. Meets performance expectations for Customer Service, Teamwork, Resource Utilization, and Staff and Self Development as outlined in performance review.
- 13. Performs other duties as assigned or directed to ensure smooth operation of the department/unit.
Bachelors of Science degree in business administration, human services, health administration, SW or other health care related field required or need to be matriculated into a Bachelor?s program and complete within 2 years of employment.
2-3 years in a health care environment.
Must be organized, able to prioritize and balance competing tasks working with many different individuals. Self-direction and ability to proactively anticipate workload is imperative. Must be able to utilize the computer for Outlook communication, website research, Excel Spreadsheets and faxing.