Hospital Case Manager

Company: ScionHealth
Location: Fontana
Posted on: March 20, 2023

Job Description:

Description

At Kindred It Starts With Me.

Our commitment is to deliver excellence and an empathetic human experience to every patient, every family member, every employee, every time. We do this through our Core Values which help in guiding our work every day.

Job Summary: The Case Manager I coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions:

Care Coordination

• Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Assists with effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate.
• Knowledgeable of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences.
• Collaborates with clinical staff in the execution of the plan of care, and achievement of goals.
  Discharge Planning
  • Under appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning.
  • Assists with comprehensive discharge planning. Utilizes critical thinking to execute effective discharge planning.
    Utilization Management
    • Conducts medical necessity review for appropriate utilization of services from admission through discharge.
    • Promotes effective and efficient utilization of clinical resources.
    • Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.
      Qualifications
      
      Education:
      
      Graduate of an accredited program required:
      • LPN or RN
      • Master of Social Work with licensure as required by state regulations;
        OR
        • Bachelor of Social Work with licensure as required by state regulations
          Licenses/Certification:
          • Healthcare professional licensure required as Registered Nurse, LPN or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
            Experience:
            • One year of experience in healthcare setting.
            • Experience in case management, utilization review, or discharge planning a plus.
              Knowledge/Skills/Abilities/Expectations:
              • Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
              • Knowledge of Medicare benefits and insurance processes and contracts.
              • Knowledge of accreditation standards and compliance requirements.

Keywords: ScionHealth, Fontana , Hospital Case Manager, Healthcare , Fontana, California