Case Manager - Acute Medical Center

LewisGale Medical Center (LGMC) delivers quality care to our patients located in the beautiful mountainous region of Southwest Virginia. LGMC is a 521-bed acute care facility and is the largest hospital in the LewisGale Regional Health System (LGRHS). Through our extensive network stretching from the Alleghany Highlands and Rockbridge County to the Roanoke and New River Valleys, we have the privilege of serving more than 250,000 patients each year. LewisGale is also ranked among the top hospitals in Virginia and the nation for benchmarked quality cancer care, patient safety and satisfaction and health outcomes. Lastly, the Centers for Medicare and Medicaid Services (CMS) have ranked us among the top hospitals nationwide on quality measures for our services and treatments to address heart attack, heart failure, pneumonia and surgical care.
Responsibilities of the Case Manager
  1. Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
  2. Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines.
  3. Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization
  4. Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of care; patient selection should be criteria based and interventions will be documented
  5. Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command
  6. Evaluates and assess observation patients for appropriateness in observation status
  7. Performs utilization management reviews and communicates information to third party payers
  8. Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
  9. Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
  10. Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
  11. Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
  12. Facilitates patient throughput with an ongoing focus on quality and efficiency
  13. Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
  14. Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
  15. Assesses patients' post discharge needs and facilitates the provision of services necessary to meet identified needs
  16. Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
  17. Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual's healthcare needs
  18. Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
  19. Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources
  20. Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care
  21. Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems
  22. Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely

EXPERIENCE Required - Three years of experience in the healthcare field in specialty areas. Possesses knowledge of utilization review, and discharge planning. Basic computer skills.

Required - Associates degree in Nursing. Must be willing to pursue BSN within hospital established guidelines.
Preferred - BSN

Required - Current license as a Registered Nurse in the State of Virginia.
Preferred - Certification in Case Management

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