POSITION SUMMARY: A Registered Nurse or Social Worker who is responsible for ensuring that hospitalized patients and Nursing home residents are actively receiving the prescribed treatment, have an appropriate discharge plan, are transitioned to the appropriate level of care and have an advocate for services along the continuum of care.
POSITION QUALIFICATIONS:
Associates Degree in Nursing or Bachelor’s Degree in Social Work required, with 2 years experience.
2 years Case management certification preferred
CPR Required, ACLS preferred
Minimum 2 years clinical inpatient experience required
Case Management experience preferred
Knowledge of RAI assessment process preferred
Background in hospital Case Management or Nursing Care preferred.
Proficient in EMR preferably Meditech. Microsoft word, Outlook, Net solutions, Keyboard 40 wpm required
Must have proven excellent advanced customer service and interpersonal skills.
Schedule:
40 hours per week, Mon. - Friday. Occasional Overtime may be necessary as business needs dictate
JOB DUTIES/REQUIREMENTS
Admission and concurrent stay reviews, using Milliman criteria, for medical necessity of acute care services which includes evaluation of the patient’s/resident’s clinical presentation throughout the hospital stay
Assessment, development and implementation of the discharge plan including transfers to higher or lower levels of care.
Patient advocacy; efforts to assist with negotiating patient/resident benefits for both acute care and post discharge needs.
Collaboration and communication with the Multi-Disciplinary Team to determine appropriate patient/resident care and discharge planning. Attendance at daily collaborative care conference expected.
Close collaboration with the attending physician in an effort to stay apprised of the patient's/resident’s clinical status, care plan, discharge plan and post hospital needs.
Assessment for and initiation of Discharge Planning intervention from admission to post-discharge.
Support readmission screening and prevention efforts by assessing admissions for appropriate level of care and correct admission status.
Consult with the patient, their family, and their physician(s) in order to facilitate timely and appropriate physical and financial acute and post-hospital care.
Initiation of crisis intervention for patients/residents and families with appropriate referrals to internal departments and outside agencies including child and adult protection.
Participate in Interdisciplinary Team Conferences in cooperation with the health care team to assess, coordinate and implement interventions for the health needs of high risk, high resource utilizing patients.
Complete assessments which include the physical, social, financial and emotional needs of the patient/resident.
Collaboration with the nursing staff to identify and evaluate the patient/resident and their family’s educational needs, their ability and readiness to learn, and their ability to properly care for the patient.
Delivery of required regulatory documentation including, but not limited to, HINNs, Medicare Important Messages, Patient Selection of Services and Code 44 notifications.
Identify and coordinate community and facility resources available for patients/residents and families; assists in providing access to these resources.
Coordinate referral, transfer or discharge to both higher and lower levels of care including the provision of pertinent documentation.
Work closely with third party payor's for utilization of resources, appropriateness of admission and service provided, denial management, audits and chart reviews.
Complete assessment of patients/residents and family needs to assess the patient's/resident’s prior level of function, immediate and post-discharge needs, social service needs and potential service referrals.
Identify and report suspected cases involving child or elder abuse and neglect to the appropriate agencies.
Identify readmissions and participates in development of mitigation strategies.
Identify appropriate cases for Utilization Review committee including protracted length of stay, failed discharge plans, readmissions and other cases needing review.
Adheres to departmental goals, objectives, standards of performance and policies and procedures.
NON-ESSENTIAL JOB DUTIES/REQUIREMENTS:
Recognizes the important part this position plays in Performance Improvement of the on-going delivery of care, as outlined in the Boundary Community Hospital Mission Statement.
Maintains strict confidentiality regarding knowledge of all patient information (HIPAA), confidential staff and hospital business.
Responsible for establishing and maintaining healthy interpersonal relationships with all staff members.
BCH maintains the right to establish work schedules and to be ensured of employee’s attendance when scheduled. Maintaining regular attendance and punctuality is a required Essential Function of this position.
Assists with special project and other duties in the department as assigned by Director.
Abides by all Federal, State and Hospital laws, regulations and guidelines.
Abides by the Boundary Community Hospital Compliance Program.