1+ months

348000 Case Manager - PD

Penn Medicine
West Chester, PA 19380
General Summary StatementResponsible for the coordination of a multidisciplinary plan of care ensuring the delivery of quality patient care that facilitates discharge and expected outcomes, utilizing appropriate and cost effective strategies. Performs and communicates clinical reviews and data to insurance payors. Collaborates with health care team to streamline patient care. Identify system barriers to cost effective quality care.Essential Duties and ResponsibilitiesCommunication Competencies1.\tCommunicates patient needs to medical staff, nursing staff, Case Management team and payers, as appropriate2.\tCommunicates patient needs with attention to detail to service providers to ensure safe level of care and appropriate resources after discharge.3.\tCommunicates with medical staff regarding case management issues as they occur and document accordingly.4.\tCommunicates with ancillary departments to: negotiate accelerated test scheduling, receive results not yet available on medical record or ensure interaction with patient as ordered by physician.5.\tRelays identified risk, infection control or patient concern issues to Risk Manager, Infection Control Practitioner, or Customer Service Coordinator as appropriate.Interventions Competencies 1.\tDiscusses the plan of care and targeted length of stay with the multidisciplinary team, patients, and family at the time of admission.2.\tExplores strategies to reduce the length of stay and resource consumption.3.\tServes as a patient advocate with the health care team, payors and outside agencies.4.\tCollaborates with primary nurses to identify plans to maintain streamlined patient care.5.\tParticipates in the daily discharge rapid rounds (multidisciplinary team meetings) coming prepared with essential information.6.\tIdentifies a plan with the Case Management Director and/or Team Lead to address system opportunities and participates in that plan.Utilization Review Competencies1.\tPerforms clinical reviews on assigned patients. Communicates reviews to insurers in a timely manner to ensure maximum reimbursement. 2.\tPerforms continued stay reviews. 3.\tPerforms daily insurance certification activities for designated commercial insurance, Medicaid, and upon request by third party payer.4.\tUnderstands and utilizes Inter Qual review criteria.5.\tCommunicates proactively with the medical staff regarding any potential/actual altered payment situations on the same day it is identified by the Case Manager.and payer.6.\tManages denials in accordance with the established protocols and procedures.7.\tConcurrently assesses patients progress or lack of progress and implements strategies to streamline care.8.\tCoordinates referrals to Physician Advisor and/or EHR to establish medical necessity.Discharge Planning Competencies1.\tInterviews and collaborates with patient/family to assess aftercare options providing guidance information and support in decision making.2.\tDevelops alternative discharge plans and coordinates with Team Leader, peers, and/or Social Worker as needed to facilitate resolution of problem dispositions or difficult patients/families.3.\tFacilitates and monitors the discharge plans and arrangements for assigned patients. 4.\tWorks with patients and their families to help them understand the impact their illness may have on their lifestyle, family, relationships and home situation.5.\tCoordinates individual patient care conferences when deemed necessary, including appropriate inpatient and outpatient personnel/agencies.6.\tDevelops a discharge plan in a timely manner to maintain lowest cost to the hospital, while ensuring a comprehensive quality plan.7.\tProcures signature on second Medicare Important Message (IMM) form for assigned patients as required by CMS 48 hours prior to discharge.Documentation Competencies1.\tRecords all patient/family activity, interaction or intervention related to discharge planning in the electronic medical record.2.\tDocuments action taken related to discharge planning within same day of interaction with patient/family and/or physician.3.\tAccurately records payor information related to review, level of reimbursement and appeal decision in the electronic medical record.in the electronic medical record.4.\tDocuments Physician Advisor and EHR referrals in the electronic medical record.

Education Training and Experience\n•\tPast experience in a leadership role preferred. \n•\tMinimum of three years of acute clinical experience in the designated specialty. \n•\tPrior utilization management and/or discharge planning or relevant experience is a plus.\n•\tKnowledge of Inter Qual Acute Care Criteria\n•\tMust have demonstrated excellent communication skills with proven ability to negotiate and collaborate with others. \n•\tAbility to be flexible, organize, prioritize and remain calm in stressful situations. \n•\tUnderstands the complexity of the health care system and is able to apply theory with practice.\n•\tMust have good computer skills. \n\nLicensure/Certification \nA Pennsylvania licensed Registered Nurse and BSN with Case Management experience\nCase Management Certification preferred

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Posted: 2021-09-28 Expires: 2021-12-25

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348000 Case Manager - PD

Penn Medicine
West Chester, PA 19380

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