Job Summary

Monitors the care and services delivered to selected patient populations during the acute hospital stay, promotes effective utilization of resources, and assumes a leadership role with the interdisciplinary team to achieve optimal clinical and resource outcomes for the acute, and posthospital phases of care. Develops and maintains a positive work climate and supports the overall team effort of the health system. The functions are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital's philosophy, policies, procedures, and standards.

Positions available:

• Clinical Case Manager – Discharge Planning, Full-time
• NEW Full-time Complex Discharge Planner, Full-time

Schedule:

• Monday – Friday, with some rotating weekend; and,
• Weekend Per Diem position is also available.

Minimum Qualifications

Education

• Master's degree in Social Work Required
• Bachelor's degree in Nursing Required
• Advanced Degree Preferred

Experience

• 3-4 years clinical experience in an acute care setting required
• Utilization management and/or case management experience preferred

Licenses and Certifications

• Licensed as a Nurse Required; or,
• Social Worker in the District of Columbia Required; and.
• Specialty certification Preferred.

Primary Duties and Responsibilities

• Advanced communication and interpersonal skills.
• Demonstrated ability to manage information for the purpose of setting goals and measuring success.
• Willingness and ability to explain case management, managed care and reimbursement concepts and requirements to physicians, patients, families, and staff.
• Willingness and ability to coach colleagues and new staff in areas of professional expertise.
• Ability to determine when a referral to other departments is required by the patient's clinical, social, or financial situation.
• Ability to interact with clinical departments as necessary to clarify components of the treatment or discharge plan.
• Ability to maintain effective communication with all members of the care team: patient, family, and hospital colleagues.
• Skill and proficiency in applying highly technical principles, concepts and techniques that are central to the health care professions.
• Assesses, facilitates, and monitors the plan of care in conjunction with the patient and/or family/significant other. Communicates the need, or lack of, continued hospitalization and ensures patient understanding of third party payer guidelines.
• Conducts concurrent chart review of selected patient populations, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and completeness of medical record documentation.
• Reviews all patient admission data within the designated timeframes to determine the suitability of the level of care in accordance with established guidelines.
• Identifies issues/problems and makes appropriate recommendations. Communicates with patients, families/ significant others, medical staff, caregivers, and third party payers, as necessary.
• Coordinates care within MGUH and other settings by monitoring and overseeing the continuum of clinical care, ensuring necessary meetings are held with patient/family and the interdisciplinary team to coordinate treatment and discharge plans. Arranges discharge-planning referrals as ordered by patient's physician.
• Serves as a facilitator/advocate for patients and families in the resolution of problems related to the established plan of care and procurement of services.
• Produces case documentation in approved manual or electronic format while maintaining required departmental standards and protocols.
• Participates in the development and standardization of improved pathway and best practice scenarios.
• Assumes other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and is not to be considered as all-inclusive.