Description

OVERVIEW

Advanced Diagnostics Healthcare System is an independent, physician-led and patient-centered organization of hospitals, clinics and diagnostic centers in Texas. We are entirely focused on bringing you advanced, comprehensive care and superior patient experience. As we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a collaborative manner.

JOB SUMMARY

This Case Manager administratively works closely with the interdisciplinary team to facilitate and maintain compassionate, safe and efficient quality care to achieve desired treatment outcomes. The incumbent will work closely with the team to ensure effective discharge planning and continuity of care as well as communicating clinical information to payers to ensure reimbursement.

With a hands-on, ‘roll up your sleeves’ work ethic, along with strong interpersonal and communication skills, as well as an enthusiastic and friendly demeanor, will ensure success for this position.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Works with physician leadership and the multidisciplinary team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality and service and patient satisfaction.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
• Proactively identifies/resolves issues impeding diagnostic, treatment progress and discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Manages all patients in observation status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.
• Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance.
• Identifies when services no longer meet criteria, initiates discussion with physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from physician advisor when needed, and informs management of possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
• Performs post-discharge review by analyzing the medical record to ensure that compliance with quality indicators is met. Communicates reports to appropriate leader regarding regulatory concerns.
• Monitors length of stay (LOS) on an ongoing basis. Proactively takes action to expedite care / facilitate discharge.
• Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state / federal agencies.
• Monitor the discharge plan implementation while identifying/addressing the patient's psychosocial and support-systems issues.
• Oversee the coordination of services and manages issues in the areas of admission/discharge, team conference/interdisciplinary plan-of-care communication, patient/family education, payor relations and total fiscal management.
• Ensure that cost-effective treatment is provided, and patient's-rights regulations are followed.

Qualifications

REQUIREMENTS

• High School Diploma or GED
• Bachelor’s Degree preferred
• Bilingual preferred
• CNA’, Medical Assistant preferred.
• Negotiation Skills
• Discharge Management
• Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management.
• Working knowledge of clinical care and payor requirements

EDUCATION

• High School Diploma or GED
• Bachelor’s Degree preferred

CERTIFICATION, LICENSURE

N/A

KNOWLEDGE SKILLS & ABILITIES

• Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
• Self-motivated, proven communication skills, assertive
• Background in business planning, and targeted outcomes
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.