W/Alt Case Manager

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Assessment/Identification of Needs:

• Continually assesses total population in assigned area re: discharge planning needs and LOS.
• Responds in a timely fashion to referrals for case manager intervention.
• Assesses overall process of referrals on assigned units and recommends interventions to improve whenever appropriate.
• Meets with patients/families/significant other and develops assessment of post hospital needs and services.
• Documents patient assessment promptly and completely.
• Works with patient and family to provide necessary education and facilitation of linkages with community services and resources.
• Provides/refers for financial counseling as appropriate.

Discharge Planning:

• Develops in conjunction with other disciplines and in a timely fashion appropriate discharge plans.
• Investigates availability of community resources and presents recommendations to physician/patient/family/significant other.
• Documents patients/family understanding acceptance of/or alternatives to discharge plan on Discharge Planning Record.
• Facilitates referral/contact with appropriate resources to meet discharge needs.
• Demonstrates effective problem solving in conflicts or complex discharge planning situations.
• Leads efficient, effective routine discharge planning meetings and other meetings R/T the facilitation of discharge planning.
• Schedules meetings between the patient/family and physicians and other disciplines as appropriate.
• Discusses obstacles to goal attainment with patient/family and providers and advocates for problem resolution.

Utilization Management:

• Screens all patients for appropriate LOC and patient type and responds promptly to make necessary adjustments.
• Performs initial reviews, obtains authorizations, and confirms post hospital care benefits.
• Performs concurrent review within time frames to obtain continued stay authorization.
• Works with physician advisor as indicated to optimize success in obtaining authorizations.
• Demonstrates working knowledge and application of Interqual criteria.
• Works effectively with medical staff to optimize appropriate resource management.
• Advocates for patients with payers to obtain coverage for needed services.

Counseling/Education/Department Support:

• Serves as resource to patient/family/significant other/staff and physicians re: community resources and post acute services criteria.
• Demonstrates appropriate knowledge base and skill R/T handling of special situations i.e., protective services, adoptions, Level II's, etc.
• Communicates to physicians and inter-departmental staff regarding Medicaid, Medicare and other 3rd party payor changes, updates and concerns.
• Cross trains effectively to various units and functions within the department as assigned.

Contribute to the overall effectiveness of the department:

• Completes other job-related duties and projects as assigned.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

The knowledge, skills, and abilities as indicated below are normally acquired through the successful completion of nursing program from an accredited school of nursing with a current Indiana license to practice as a Registered Nurse, a Bachelor's (BSW) or Master's (MSW) of Social Work. A minimum of one to two years of job-related experience is required. After January 1, 2014, candidates are required to have or obtain a BSN within five (5) years of employment as a Registered Nurse or will have the option to become certified in their area of specialty. The certification must be maintained based off of accrediting body standards.

Knowledge & Skills:

• Possesses outstanding interpersonal skills with focus on listening, assertion, conflict resolution and collaboration.
• Understands function of complex healthcare organization providing broad scope of services.
• Ability to communicate positively and effectively with all levels of participants in health care delivery in both formal and informal settings and with individuals as well as groups of varying size and through documentation.
• Clinical expertise appropriate for designated patient population.
• Skill in auditing outcomes concurrently and retrospectively.
• Capable of managing complex workload and establishing priorities.
• Maintains up-to-date knowledge of reimbursement processes and community resources.
• Knowledge of health care delivery systems across the continuum of service providers.

Working Conditions:

• Complexity of workload and communications may involve mental stress.
• Must commit to a weekend alternative schedule.

Physical Demands:

Physical demands generally light, but at times may require direct patient contact (lifting, bending, exposure to biomedical hazards).