JOB SUMMARY

• The Case Manager assures timely, resource-effective transition planning, with respect for the patient and family as individuals within their psychosocial and cultural framework. Across the continuum of care, the Case Manager coordinates the planning of post-discharge services by collaborating with patients and their families, physicians, other members of the health care team, and representatives of payers and community agencies/facilities. The Case Manager assesses the psychosocial and clinical situation, assists patients and families in engaging in the discharge plan, accesses services, advocates for patients, and explores all possible options in order to achieve the highest quality clinical outcomes with the most cost effective and timely use of available resources.

• Assessment
  • Assesses the patient's psychosocial situation including medical, family, social, emotional, psychiatric, cultural, spiritual, financial and environmental factors, as indicated by the patient's situation. Documentation reflects all indicated elements.
  • Evaluates insurance status, including coverage for a range of potential discharge plans (i.e. home, sub-acute Rehab, acute Rehab, MH, chemical dependency, etc.).
  • Documents complete initial assessment in the medical record and ongoing assessments as patient status evolves.
• Transition planning
  • Collaborates with physicians, nurses, physical therapists, other services, patients and/or families and community agencies or facilities to develop an appropriate discharge plan.
  • Implements this plan, coordinating needed services (transportation, equipment, supplies, etc.) and documents in the medical record.
  • Actively engages the patient/family and significant others in developing such plans.
  • Communicates effectively about these plans, through individual contacts, interdisciplinary rounds, and documentation in the medical record.
  • Provides information about community agencies and facilities to families and actively encourages them to access them.
  • Provides education and support to patients and families to help them integrate the plan and engage in doing their part to make it effective.
  • Monitors the patient's progress and adapts plans accordingly.
  • Collaborates and communicates effectively with other case managers as well as staff and managers from other units/departments to ensure smooth transitions for the patient and family within the hospital system.
• Resource management
  • Uses severity of illness-intensity of service criteria to determine appropriateness of admissions, transfers, continued stays, and discharges.
  • Addresses potential denials proactively to prevent or avert unnecessary admissions.
  • Identifies unnecessary admissions and implements processes to reverse them.
  • Effectively implements D/C appeal process when requested by patient/family.
  • Identifies avoidable days and communicates effectively with physicians and hospital departments about them.
  • Intervenes effectively in hospital systems and processes to expedite services that will facilitate the process of care in a timely manner. Successfully shortens a patient's LOS with these interventions.
  • Collaborates with UR Data Coordinator to ensure timely concurrent and retrospective reviews for payers, and to provide any information that would assist the hospital in appealing a denial.
  • Completes insurance reviews in a timely manner, resulting in no denials that are attributable to a delay in review.
  • Communicates effectively with payers by telephone and through the on-site liaisons to advocate for needed services for patients and accurate reimbursement for the hospital.
  • Collaborates with physician liaison to address delays in service and/or obstacles to discharge.
• Advocacy for quality outcomes
  • Maintains knowledge of relevant clinical, community, and fiscal issues that impact patient outcomes.
  • Demonstrates problem-solving skills in order to obtain needed services. Utilizes unique and innovative solutions requiring research beyond the local community.
  • Maintains positive working relationships with hospital and community professionals to optimize patient outcomes.
  • Maintains supportive and positive relationships with patients and families.
  • Participates in projects that will improve outcomes and/or conserve resources.
  • Identifies opportunities for the department to learn from other agencies and facilities. Initiates contact, evaluates potential benefit and organizes in-service.
  • Participates in providing or enhancing education and/or resources for other hospital staff. Identifies the need and develops a method for meeting it.
  • Participates in community programs and/or collaborative projects that will enhance quality outcomes.
• Other
  • Performs other related duties as assigned.

• EXPERIENCE
  • 3 - 5 years relevant experience working with complex medical and psychosocial situations. Knowledge of community resources, insurance and publicly funded programs.
• EDUCATION
  • Graduate of an accredited School of Nursing. BSN preferred
• LICENSES/CERTIFICATIONS
  • Current NYS RN license required
  • Certification in PRI desired
• OTHER
  • Computer literacy.
  • Ability to function effective in a challenging environment, with simultaneous attention to multiple complex tasks.
  • Ability to deal supportively with patients, families and staff in stressful situations, while maintaining a focus on the importance of timely discharge planning.
  • Ability to advocate, within the hospital and within the community, to overcome obstacles to effective and timely implementation of the discharge plan.
  • Ability to communicate effectively with individuals and groups through oral and written communication skills and documentation in the medical record.
  • Knowledge of applications and functions of personal computers, printers, and mainframe computer terminals, fax machines, copiers, and telephone system.
• SPECIAL REQUIREMENTS
  • N/A

About Us:

MidHudson Regional Hospital

MidHudson Regional Hospital in Poughkeepsie, NY, is home to the mid-Hudson Valley's most advanced healthcare services. This 243-bed facility cares for more than 10,000 inpatients annually while performing an additional 325,000 outpatient procedures each year. MidHudson Regional Hospital operates the area's only Level II trauma center, is home to the Redl Center for Cancer Care and Center for Robotic Surgery, and is a destination hospital for patients with serious illnesses and injuries.