Job Description
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POSITION SUMMARY Reporting to the Director of Care Management, the Care Manager is responsible for managing the continuum of care from admission through discharge for assigned patients. The role reflects appropriate knowledge of RN scope of practice, current state requirements, CMS Conditions of Participation, EMTALA, The Patient Bill of Rights, AB1203 and other Federal or State regulatory agency requirements specific to Utilization Review and Discharge Planning. The Care Manager partners with the medical staff, utilizes scientific evidence for best practices, and relevant data to manage the care of the patient over the continuum of care from pre hospitalization through discharge. These activities include admission, continued, extended and discharge reviews in all reimbursement categories to determine medical necessity, assure high quality of care and efficient utilization of available healthcare resources, facilities and services. This position requires the full understanding and active participation in fulfilling the Mission of Martin Luther King, Jr. Community Hospital. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support Martin Luther King, Jr. Community Hospital's strategic plan and the goals and direction of the quality and performance improvement process activities.
ESSENTIAL DUTIES AND RESPONSIBILITIES - Is a role model for the Hospital's Patient Satisfaction effort when interacting with customers, subordinates and colleagues.
- Collaborates with the interdisciplinary team participants in team rounds to: facilitate timely care; sssure quality of care throughout the
- hospital stay; and minimize adverse outcomes.
- Initiates appropriate referrals to the internal interdisciplinary team.
- Communicates with Admitting or PFS regarding the needs of the patient, payer and provider are supported within the limitations of the existing individual benefit structure.
- Communicates relevant elements of the health plan benefits.
- Establishes a working diagnosis (DRG) on every patient at the time of admission to estimate the target length of stay or identify the date of discharge for planning and care coordination purposes.
- Communicates target LOS/estimated discharge readiness to physician, patient, family, care team and payor.
- Documents all team, physician and patient/family communication and concerns pertaining to coordination of care and services.
- Screens every patient to identify need for further assessment of medical necessity or discharge planning (standard description of which patients are seen). 11. Adheres to the Care Management Department policies and procedures.
- Participates in the Quality and Performance Improvement Plan for the Care Management Department.
- Considers the patient population served, age-specific criteria and the Watson Model of Care in all patient/family care and interaction.
- Utilizes Milliman Care Guideline's best practices to determine patient disposition. Collaborates with on site Hospitalists, Intensivists, Laborists and Emergency Department physicians in this process.
POSITION REQUIREMENTS A. Education
- Bachelor of Science degree in nursing preferred
- Associates degree in nursing required
B. Qualifications/Experience
- Minimum of one (1) to three (3) years of hospital or related experience required. Internals with at least 18 months acute care case management/coordination experience will be considered in lieu of nursing clinical experience.
- Able to navigate and connect successfully with outside provider networks (Health Plans, IPA's, and FQHC's).
C. Special Skills/Knowledge
- Bilingual language skills preferred (Spanish)
- Current California Nursing license
- Current Basic Life Support (BLS)
- Certification in Case Management preferred.
- ED Care Managers: Must complete annual Workplace Violence Prevention Program/Certificate, per hospital policy, during initial training/orientation but not to exceed 9 0 days from hire/transfer.
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Job Tags
Full time, Night shift,