Establishes excellent rapport with community resources and partners.
Committed to working as a team to improve Employee satisfaction and Employee Engagement scores.
Plans the patient discharge upon admission guiding the patient and family using expected DRG timeframes and appropriate and safe discharge to next level of care.
Demonstrates leadership and initiative in all daily activities. Provides professional example for staff in attitude, support of facility goals, and guest relations. Maintains a high level of case management expertise.
Works cooperatively as a team member to identify and solve facility-wide needs and improve operation.
Follows correct company procedures when dealing with patients and families.
Correctly handles patients according to age and level of understanding.
Assures team and family conferences are conducted according to policy and procedure.
Schedules and conducts family conferences at periodic intervals throughout the patient stay and as necessary, including Care Coordination Conferences (C-3 Meetings) within 72 hours of admission.
Effectively interacts with patients, families, and visitors to enhance guest relations. Represents the facility in all contacts with other health professionals and the general public
Introduce self to patient/family within 72 hours of admission or based on clinician referral and explain CM role. Complete discharge planning screening tool within 72 hours for patients. Provide Parent/Patient/ Guardian/ Significant Other with discharge planning education/instruction based on assessed education level, barriers to learning and learning preferences to assure a positive discharge outcome.
Reviews discharge screens on admission database completed by RN within 24 hours of admission.
Submits Physician Advisor referral for physician related discharge issues/obstacles.
Discusses obstacles to discharge weekly during Outlier Meetings with Physician Advisor, Lead Case Manager and COO.
Maintains knowledge of providers at next level of care in our market and surrounding markets.
Informs COO and Lead Case Manager of all major conditions, subsequent changes, and emergency situations. Submits accurate and thorough work on time. Completes data collection and tabulation of statistical information as directed.
Assures medical necessity review criteria, as mandated by the QIO, is implemented for all admissions and continued stays. Assures thorough and timely completion of utilization review and non-Medicare utilization.
Maintains an up-to-date community resource system and assists patient and family in gaining knowledge of, and access to, appropriate services.
In Conjunction with the Clinical Services Department, assures clinical documentation is in accordance with payor guidelines for reimbursement.
Attends IDT meetings as scheduled.
Conducts discharge time out prior to patient discharge.
Conducts conference with patients discharging to home.
Follows up on Advanced Directive Flowchart upon admission.
Provide interventions for end of life decision making and act as a liaison with the Ethics Committee. May include interfacing with the Palliative Care Medical Director.
Schedules out of facility patient tests and treatments and arranges ambulance transportation.
Assures team conference reports are professional and appropriate in conjunction with clinical services.
Performs other duties as assigned.
What You Will Need:
Graduate of an accredited School of Nursing (RN), Specific Degree/Major: Nursing,
Minimum of One year experience in Case Management in an acute care environment.
Current license of registered nurse in Florida or licensure from another state with verification of application of eligibility
for Florida licensure by endorsement
Individuals must possess these knowledge, skills and abilities and be able to explain and to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.
Application of InterQual® Criteria set.
Assessment competency and knowledge application for all ages served within the long term acute care environment.
Assessment competency for appropriate use of hospital services and care coordination.
Excellent oral communication skills and interpersonal relations.
Excellent written communication skills.
Excellent computer skills.
Ability to work independently.
Innovative and creative in identifying discharge options for medically complex patients.
Nice to Have:
Greater than Three years experience.
Any combination of education, training or experience that provides the knowledge, skills and abilities required to successfully accomplish the assigned duties and responsibilities of the position.
Specific experience in Case Management and discharge planning.
Working knowledge of the insurance industry and government reimbursement for healthcare settings.
Basic Life Support (BLS) Certification
Certification in Case Management (CCM)
The Case Manager is accountable for the organization, sequence of services and resources that are necessary and appropriate for the achievement of patient care outcomes within effective time frames on a specific group of patients. The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and financial management, while also completing medical record documentation. The Case Manager reports to the CEO and Lead Case Manager. In addition, the Case Manager will coordinate the plan of care among all members of the health care team. The Case Manager must have the professional ability to practice under minimal supervision and perform the following seven essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation, with emphasis on decreasing length of stay and monitoring cost effective health care across the continuum of care. The Case Manager must complete all initial admission assessments within 24 hours of inpatient admission and match the patientâ€™s ongoing needs with the appropriate level and type of medical, health, psychosocial, or social service as they relate across the continuum of care.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.