Case Mgr Supv - Case Management

Position Summary

Provides supervision and acts as a resource for case managers to coordinate a continuum of care for patients from admission through discharge; assures that patients and families proceed efficiently through the course of hospitalization; moves patients through the hospital system in a cost effective manner resulting in the optimal discharge plan. Collaborates actively with the Medical Staff, department directors, and payors and outside organizations to appropriately manage the care of patients in a high quality cost effective manner.


CLASS CHARACTERISTICS

Incumbents in this class are responsible for supervision and direction of case managers for screening patient pre-admission, ongoing review of patient medical records pertaining to the quality of patient care, maximizing reimbursement for services provided and provide optimal discharge planning.



POSITION QUALIFICATIONS

A combination of appropriate education and experience that would likely provide the required knowledge and abilities.

Education

Associate of Science Degree in Nursing, Possession of current California Registered Nurse License

Bachelor’s Degree preferred

Experience

Two (2) years recent acute hospital nursing experience in UM, DC planning, Case Management or equivalent.



KNOWLEDGE & ABILITIES

Knowledge of:


InterQual guidelines

Joint Commission and other regulating agency policies and guidelines.

Payor source documentation requirements and governmental regulations affecting reimbursement.

Hospital nursing principles, methods, and commonly used medical procedures.

Common patient disease processes, and the usual methods for treating them.

Medical terminology, hospital nursing facility routine, and commonly used equipment.

Identification of potential discharge needs.

Community resources; hospital nursing facility organization and the interrelationship of various clinical and diagnostic services.


Ability to:

Supervise and coordinate Case Management activities.

Provide training.

Provide in-put and recommendations for revision and implementation of policies and procedures.

Coordinate staffing needs.

Maintain records for staff and Case Management activities.

Prepare reports for Administration.

Evaluate the medical record to assess appropriateness of acute hospitalization as related to     intensity of service and severity of illness

Make recommendations regarding continued stay necessity, appropriateness of the level of the delivery of care.

Identify discharge needs. Assess available resources and formulate appropriate discharge plan.

Communicate documentation needs in a manner that promotes cooperation.

Gather and analyze data and prepare reports and recommendations.

Work effectively with physicians, other health providers, outside payor sources, community resources, and the general public.

Relate positively with patients and families; demonstrate crisis intervention skills.

Collaborates with other nursing personnel, physicians and health care professionals regarding the plan of care.

Manage emergency or crisis situations.

Assess patient/family needs for post discharge care. Plans and implements quality, efficient discharge plan, enabling patient to function at their highest level of independence.