This position performs a major role in the monitoring and evaluation of patient care practices.This person assists in meeting the psychosocial needs of patients and provisions of discharge planning services to patients and their families with personal or environmental difficulties which may interfere with obtaining maximum benefits from medical care, assuring timely discharge and effective post-hospital care. This person must be able to apply the six essential activities within the five core components of: Coordination and Service delivery; Physical and Psychological factors; Benefits systems and cost benefit analysis; Case management concepts; and Community resources. The six essential activities are: Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation. These core components and essential activities must be applied across a continuum of care that addresses the ongoing needs of the individual being served by case management process, and deal with the person’s broad spectrum of needs. Reviews all denials and appeals decisions as appropriate. Performs insurance pre-certification and updates.Assist physicians with coordination of patient care during and after hospitalization.

• 1.This position requires knowledge of Case Management policies and procedures and State and Federal regulations regarding medical necessity for admission and discharge screens.
• 2.Knowledge of community resources and discharge planning, along with the technical skills necessary to demonstrate alternative care programs to patients and their families.
• 3.Frequent interactive, interpretive and consultative associations are inherent to this position.
• 4.The ability to retrieve, communicate, and presents data and information verbally and in written form is required.
• 5.Strong interpersonal skills and the ability to communicate effectively with patients , families, nursing staff, physicians, associations and community resource liaisons are inherent to this position.
• 6.Performs assessment of patient’s needs, plans interventions with objectives and goals from the assessment with implementation of case management activities to meet them. Coordinates the obtainment of community resources necessary to accomplish those goals in the case management plan with monitoring and an evaluation to determine effectiveness.
• 7.Demonstrates the ability to provide interventions based on age-specific criteria and departmental patient care standards.
• 8.Demonstrates knowledge of infection control guidelines and the following of the seven safety plans: safety, security, hazardous materials and waste, emergency preparedness, life safety, medical equipment, and utility systems.
• 9.Provides the information to determine the medical necessity of all admissions and the need for continued stay and identifying inappropriate or untimely services to focus on opportunities to reduce inappropriate patterns of utilization.
• 10.Discharge planning assessment and coordination of all ages to begin in the pre-hospital phase and coordinating the delivery of services to meet patient’s discharge needs.
• 11.Observe professional ethics in maintaining confidential information acquired concerning the personal, financial, and medical or employment status of patients at Livingston Regional Hospital.
• 12.Performs pre-certifications for insurance, HMO, MCO, etc timely and accurately.
• Performs other job duties as needed.

Education:

Bachelor Degree: Required 

LPN: X

Previous experience: Preferred