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.
Coordinates the care, treatment, and services of selected patient populations through the acute care episode, across the continuum. Works collaboratively with interdisciplinary teams, both internal and external to Milford Hospital, to improve patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to achieve desired clinical, financial, and resource outcomes. Remains current regarding third party payer’s rules, regulations and requirements.
POSITION DUTIES AND RESPONSIBILITIES
1) Case Management
Assesses patient and family needs in preparation to return to the community. This assessment will begin on admission and will continue until time of discharge.
Plans with the patient, family and physician for return to the community according to goals and continuing care needs, patient’s wishes, and patients living arrangements
Implements a smooth transition from hospital to the appropriate level of care based on the patient’s needs by accessing community resources including home without services, home with home services, support services, extended care facilities for short term rehabilitation or long term care, hospice care, mental health services, acute inpatient, or outpatient services.
Coordinates timely and appropriate referrals to social workers, dietitians, rehabilitation medicine and other disciplines as needed by patient. Consult Social Work at the earliest opportunity to initiate and complete the common application to facilitate the placement plan of care.
Monitors the patients progress toward the desired outcome by developing suitable and timely continuing care plans
Advocates for patient and family by ensuring appropriate referrals are made to achieve desired patient outcomes.
Serves as a liaison between physicians, other care-givers, and members of the Quality Improvement Team.
Convenes and conducts weekly interdisciplinary utilization review conferences on on designated units to solicit input the patients status from clinical and business team members
Meets with Clinical Managers on assigned units every morning to assure new clinical information and readiness for discharge is up- to -date.
Cooperates within the case management team to efficiently and effectively manage the workload.
2) Utilization Review
Evaluates the appropriateness of clinical resource utilization for assigned caseload and expedites the scheduling of tests and procedures as required to move patients through the system in a fiscally responsible way.
Achieves Length of Stay targets.
Participates in performance improvement projects relevant to assigned patient population.
Evaluates resource utilization from admission to discharge and takes appropriate action as necessary. Timely requested third-party reviews are expected and a case management note on the chart every 2-3 days and more often if needed.
Coordinates patient care treatment and services authorized by third-party payers
Confers with physician to confirm appropriateness of patients admission and
continued stay in the acute care setting.
Issues Important Message from Medicare Notice (IM) to all Medicare patients including managed and tertiary within 24 to 48 hours before discharge.
Notifies Director of Case Management with all patients/families who do not agree with the discharge day.
3) Quality Improvement
Anticipates possible risk issues, proactive with the interdisciplinary team to promote optimal patient outcomes, reduce potential patient safety concerns, and maximize benefits from the resources available.
Serves as a resource and provides education to patients, physicians and professional staff on levels of care, quality –of-care issues, and regulatory concerns.
Continually evaluates case management services and client outcomes.
Fosters positive internal and external customer relations
EDUCATION: BSN Required
EXPERIENCE: A minimum of 3-5 years relevant clinical experience as a Registered Nurse. At least two years of recent experience in case management, utilization review,and/or discharge planning in a facility is required. Experience in the case management or utilization review in the hospital setting is preferred.
Other Skills: The Case Manager is a professional RN empowered with the knowledge, responsibility and accountability for managing patient care throughout the episode of illness to improve quality, cost and service satisfaction outcomes. The Case Manager must possess strong interpersonal skills, leadership, negotiation skills, and knowledge of Milford Hospital operations. General knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential.