Department:
16301_77560 Case Management - SM
Expected Weekly Hours:
20
Shift:
Day Shift
Position Purpose:
ER Case Manager Part Time 20 Hours
Job Description Details:
SUMMARY:
A Case Manager is required to function at an advanced level of nursing and is required to understand the importance of disease management, critical pathways, continuum of care from admission through to discharge.
The Case Manager will assess patient needs, facilitates inpatient planning using criteria sets, collaborating with physicians and other healthcare providers to develop a safe and appropriate plan of care for patients.
A Case Manager may work in the Emergency Center, the Birthing Center or on the medical/surgical floors with either inpatients or Observation patients, depending on their pre-determined assignment.
PERFORMANCE DUTIES
Reviews admissions for appropriateness based on InterQual criteria guidelines.
Communicates with the admitting physician as needed to determine that patient receives the right care, the right place, at the right time.
Facilitates appropriate documentation to support admission.
Documents severity or illness and intensity of service criteria on all patients.
At Emergency Center entry to the hospital this information is entered into the Cerner system.
Obtains all necessary clinical authorizations as required.
Ensures services are being utilized at the appropriate level of care and escalates issues as appropriate.
Interviews patients, families and other care providers to obtain information necessary to plan and implement a coordinated discharge and documents on the Case Management form in Powerchart.
Educates patients and families on disease processes, resources available in the community, as well as assisting patients in the benefits of case management while in the hospital setting.
Concurrently reviews patient's medical conditions, proactively communicates with the physicians, families and other ancillary staff to ensure that patients receive the right care, in the right place, at the right time.
Conducts concurrent call-ins to patient's insurance company as required to ensure that authorization is maintained for the continued stay in the hospital. Refers cases to the Denials/Appeals/UR Coordinator as appropriate.
Documents pertinent information regarding the patient's plan of care, as well as information regarding payors, discharge plans into the selected computerized database in a timely manner.
Communicates with the physician regarding accurate documentation to support the most appropriate DRG.
Responsible for the day-to-day coordination of their assigned patient caseload with referral to Medical Social Worker for assistance when indicated
Initiates referrals to outside agencies for continuum of care as indicated, utilizing appropriate resources for and facilitate an appropriate, safe placement for patients released from the hospital.
Maintains a comprehensive knowledge of payor requirements for authorization.
Serves effectively as a patient/family advocate. CM participates in family meetings and team conferences concerning patient care.
Serves as an educator to patients, families, and nurses. The case manager provides patient centered care and strives for a positive experience for the patient.
Utilizes critical thinking and problem solving skills to analyze and synthesize all data to formulate an appropriate discharge plan for the patient.
Coordinates care prior to the patient being discharged. This may include DME, IV Abx, Pleur X, and Wound Vacs.
Participates in process improvement activities that require Case Management engagement.
JOB REQUIREMENTS:
Bachelor of Science degree in Nursing or health related field or equivalent work experience.
Current licensure to practice in Nursing in the State of Michigan.
Progression toward or a completed certification in case management required.
Current Basic Life Support (BLS) certification.
JOB EXPERIENCE
Five years of clinical experience in nursing and recent (within 2 year) experience in utilization review/management/discharge planning or case management.
Current knowledge of third party payor programs, requirements and applied criteria.
Knowledge of federal, state and local regulation affecting utilization review programs and payments.
Knowledge of regulatory and accrediting agency standards and regulations relative to utilization review.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually.
Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $24.7 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 133,000 colleagues, including 7,800 employed physicians and clinicians.
Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services - ranked by number of visits - in the nation, as well as the nation's leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org at http://www.trinity-health.org/ . You can also follow @TrinityHealthMI on Twitter.