Case Manager

Case Manager Apply! Apply! Position Details

Department: PCH-NW | Case Management

Category: Care Mgmt/Social Wrk/Case Mgr

Location: Glendale

Employee Type: Regular

Posting #: 831192

Posted On: 4/17/2024

Position

Summary

The position provides comprehensive care coordination for patients as assigned and assesses the patients plan of care. The Case Manager is responsible for Length of Stay management and discharge planning. Develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, advocating and facilitating options and services to meet the patients health care needs. Interacts extensively with the care teams to support the clinical roadmap. The intensity of care coordination provided is situational and appropriate based on patient need and payer

requirements. This position works independently, receiving supervision of work activities from the Lead CM team, Supervisor of Case Management and Manager of Case Management and is accountable for the quality of clinical services delivered by both them and community partners and identifies/resolves barriers which may hinder effective patient care.

Position

Duties

Coordination of CareManages a defined service line patient population to achieve optimal discharge and continuity of care outcomes in a manner that promotes sound financial stewardship and patient-family advocacy.Establishes estimated Length of Stay via MCG criteria and tools,Completes an initial screen of all patients on admission (not to exceed within 24 hours of admission) utilizing MCG criteria to identify needs related to care coordination and/or discharge planning. Leveraging MCG and other evidence-based guidelines, coordinates development and implementation of a comprehensive discharge care plan in collaboration with the clinical care team. Ensures plan of care is in place with all team members. Proactively collaborates with members of the interdisciplinary clinical care team to define and document a clear and comprehensive treatment plan, including post-discharge needs. Identifies and facilitates resolution of variances in the plan of care that may impact length of stay. Facilitates referrals to other disciplines, and monitors for appropriate follow-up. Facilitates and provides on-going communication with patient/family and escalates unresolved barriers to timely discharge to Case Management, Manager or Utilization Management Medical Director, as per department protocols.Reviews and analyzes third-party payer denials for in house patients, and communicates to attending physician , Case Management, Manager, Utilization Management Medical Director, and Utilization Management Nurse as per department protocols. Cultivates and maintains effective interaction/communication with members of the interdisciplinary care team and proactively engages patient and families in the delivery of care across the continuum of care. Reviews the patient daily for appropriate patient status , level of care and goal length of stay per established Case Management daily prioritization protocol , utilizing MCG criteria and communicates goal length of stay to clinical care team, patient and family.Keeps patient discharge information current in Case Manager EMR documentation. Assesses each patients status and activities daily as appropriate to patient needs. Ensures timeliness of care and identifies barriers to transition of care or discharge. Participates in interdisciplinary rounds and/or service line rounds with clinical care team. Regulatory

responsibilitiesReviews the patient daily (Observation and Inpatient) for appropriate status and meeting admission or discharge criteria. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct ongoing care planning and discharge planning. Utilizes MCG guidelines/pathways to determine admission status, level of care, goal length of stay and continued provision of services as evidenced by audit of documentation in EMR. Documents avoidable days, extended length of stay, authorizations and denials for medical necessity in SCM and SAM as evidenced by audit. Communicates to Utilization Management Nurse data supporting denial appeals, or notification of potential denials. Communicates with payers to resolve potential denials. Working knowledge of DRG payment methodology and ICD-9/10 coding system.Provides Medicare/Tricare Rights and Detailed Notice of Discharge to patient and families. Transition and Discharge PlanningAssures thorough, early and ongoing transition/discharge plans by collaborating with patients, families, payers and providers across the continuum of care. Assesses patient for appropriate discharge placement. Identifies presumed discharge

location on admission. Consults with social services and other resources as needs or problems are identified. Communicates transition/discharge plans and problems to other case managers as care is transitioned. Ensures that health care team is proactive in making arrangements for transition/discharge, and ensures that each transition/discharge plan has clear goals that are attainable. Ensures that all elements of patients` needs are addressed in the transition/discharge plans. Validates that family and patient are aware and understand discharge plan as demonstrated by documentation and feedback. Ensures that

education and teaching for family and patient to support transition/discharge is begun as quickly as possible with the health care team. When appropriate, performs outpatient and clinic care coordination and monitors patients care as they transition between inpatient and outpatient service. Provides excellent customer serviceEnsures that all elements of patients` needs are addressed in the transition/discharge plans. Keeps families and patients involved and informed as demonstrated by feedback. Facilitates and provides on-going communication with patient/family and interdisciplinary staff to identify and resolve potential barriers to discharge Communicates with payers to resolve potential denials. Responds to emails within 24 hours. Clear communication

skills with all internal and external customers. Provides excellent service routinely in interactions with all customers, i.e. Co workers, patients, visitors, physicians, volunteers, etc. Leadership care coordinationProvides unit and team leadership demonstrates strong, consistent clear communication and serves as central point of information informing all team members, including physicians, on patient status and goal length of stay.Keeps families and patients involved and informed as demonstrated by feedback. Cultivates and maintains effective interaction/communication with members of the medical staff, nursing staff, social workers, Utilization Management team and families to drive the care coordination process and to facilitate continuity of patient care. Performs miscellaneous job related

duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical

education.

We Realize This Vision By

Offering the most comprehensive care across ages, communities and specialtiesInvesting in innovative research, including emerging treatments, tools and technologiesAdvancing

education and training to shape the next generation of clinical leadersAdvocating for the health and well-being of children and families

Values

We place children and families at the center of all we doWe deliver exceptional care, every day and in every wayWe collaborate with colleagues, partners and communities to amplify our impactWe set the standards of pediatric healthcare today, and innovate for the futureWe are accountable for making the highest quality care accessible and affordable

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Position

Qualifications Please Review The Following

qualifications and specify whether you meet each of the

requirements listed.

Education Do you meet this requirement?

Bachelors degree in Nursing or a combination of Associate degree in Nursing coupled with 3 years clinical

experience.

Required

Yes No

Masters Degree In Nursing

Preferred

Yes No

Experience Do you meet this requirement?

Minimum of (1) year of broad clinical

experience. Care coordination, case management, discharge planning and utilization review

experience preferred.

Required

Yes No

Working knowledge of the financial aspects of third party payers and reimbursement.

Preferred

Yes No

Working knowledge of the use of evidence-based guidelines to effectively manage length of stay.

Preferred

Yes No

Certifications / Licenses / Registries Do you meet this requirement?

Current State Of Arizona Rn License Or Compact State Rn License

Required

Yes No

Case Management Certification (CCM)

Preferred

Yes No

Current BLS Certification for Health care Provider from the American Heart Association

Required

Yes No

Valid AZ Department of Public Safety (DPS) Fingerprint Clearance Card

Required

Yes No

Special

Skills Do you meet this requirement?

Bilingual (Spanish)

Preferred

Yes No

Mcg Criteria Knowledge

Preferred

Yes No

Excellent Communication

skills, both verbal and written.

Required

Yes No

Effective Critical Thinking

skills and ability to anticipate patient discharge needs.

Required

Yes No

Moderate To Expert Computer

skills

Required

Yes No

Effective Decision-making /problem-solving

skills, demonstration of creativity in problem-solving, influential leadership skill.

Required

Yes No

Physical

Requirements & Occupational Exposure/risk Potential

Physical Requirement - Fine Motor

Skills (pinching, gripping, etc) - Occasionally Physical Requirement - Hearing - Constantly Physical Requirement - Pushing/pulling - Occasionally Physical Requirement - Reaching - Occasionally Physical Requirement - Sitting - Constantly Physical Requirement - Standing - Constantly Physical Requirement - Stooping/crouching/kneeling/crawling - Occasionally Physical Requirement - Talking - Constantly Physical Requirement - Walking - Constantly Physical Requirement - Near Vision - Constantly Physical Requirement - Far Vision - Constantly Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly Physical Requirement - Lift up to 35 pounds without assistance - Occasionally Occupational Exposure/Risk Potential - Inside office environment - Applicable Occupational Exposure/Risk Potential - Airborne communicable diseases - Applicable Occupational Exposure/Risk Potential - Bloodborne pathogens or bodily fluid - Applicable

I Have Reviewed The

qualifications, physical

requirements and occupational exposure/risk potential for this position and wish to apply

I Agree