St. David's Medical Center is part of St. David's HealthCare, one of the largest health systems in Texas, which was recognized in 2014 with a Malcolm Baldrige National Quality Award . Founded in 1924, St. David's Medical Center is a full-service medical center offering comprehensive medical care at three locations-St. David's Medical Center, Heart Hospital of Austin and St. David's Georgetown Hospital . Located in central Austin, St. David's Medical Center includes a 350-bed acute care hospital and a 64- bed rehabilitation hospital providing comprehensive inpatient and outpatient care. It is home to the internationally renowned Texas Cardiac Arrhythmia Institute and St. David's Neuroscience & Spine Institute . The hospital provides a complete range of women's services, including its acclaimed maternity unit, maternal-fetal medicine, a high-risk maternal and neonatal transport team, the region's largest and most sophisticated Neonatal Intensive Care Unit and The Breast Center ; complex surgical services; a comprehensive Bariatric Surgery Center ; and a 24-hour emergency department. POSITION SUMMARY
The Case Management Manager provides overall coordination in the delivery of services and discharge planning for specified patient population. Performs concurrent analysis of patient records for purposes of utilization review and quality assurance. Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physicians and funding representatives. Ensures continuity in the delivery of services across St. David's entities. ESSENTIAL JOB RESPONSIBILITIES
Financial Planning and Coordination
- Works cooperatively with Admissions Office and Business Services to facilitate and ensure proper pre-certification and assignment of accommodation status for hospitalized patients.
- Monitors all admissions on assignment unit to communicate crucial patient information regarding policy coverage, limits, required documentation and other relevant financial characteristics of coverage to appropriate facility staff and medical providers.
- Ensures required documentation and justification is provided to third party payors to obtain re-certification for continued hospitalization and treatment as needed.
- Serves as liaison between interdisciplinary care team and funding sources, maintaining contact as required to report patient's status, progress, required treatments, and estimated necessary length of stay.
- Works with the patient and family to identify financial resources available to them in provision of necessary services, either inpatient or post-discharge.
- Provides routine reports on effective utilization of case management services related to cost containment and interventions resulting in a more positive outcome with patient, family, funding source or other involved party.
Treatment Planning and Coordination
- Participates in the assessment of patient clinical and psychosocial needs through review of patient information, personal contact with patient and family, and interdisciplinary care team conferences.
- Serves as liaison between members of interdisciplinary care team, funding source, patient, family, and outside case manager to ensure treatment is met within quality standards and in line with funding stipulations.
- Schedules and coordinates conferences as needed.
- Works cooperatively with members of interdisciplinary care team in the development, implementation and review of the case management plan, in the coordination of patient service delivery, and in the concurrent clinical review process.
- Communicates routinely with the patient, family, interdisciplinary care team members, outside case managers and other appropriate parties with regard to status of patient treatment plan and progress toward treatment goals, identification of concerns and/or problems, problem-solving and assisting with conflict resolution when necessary.
- Utilizes clinical and financial tools such as care management plans and financial profiles in the concurrent assessment and management of patient service delivery.
Discharge Planning and Continuity of Care
- Collaborates with interdisciplinary care team, cross-campus SCHCS service liaisons, patient and family in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs, delivery of post-discharge services and transition of the patient from the hospital to the discharge setting.
- Collaborates with other care team members to assess the need for social service referrals for complex discharge planning interventions.
Qualifications: EDUCATION AND EXPERIENCE Required:
- Performs first level concurrent analysis of patient records on assigned unit for purposes of utilization review and quality assurance.
- Works cooperatively with and reports information to Director of Utilization Review and Vice President of Medical Affairs in surveillance and data collection for focused UR/QA studies.
- Attends and participates in health care system committees and departmental meetings as requested.
- Actively supports and participates in the health care system Total Quality Management initiative as evidenced by attendance at educational programs, participation in process improvement teams, and/or providing technical assistance for the TQM educational effort.
- Prepares and presents inservice and training programs as requested.
Registered Nurse with clinically focused work history. Preferred:
Minimum three years clinical experience within an acute health care setting preferred. Prefer previous recent work history in acute care case management role. Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, discharge planning, and reimbursement structures (i.e. Medicare, Medicaid, HMO). Licenses and Certificates Required:
Current Texas RN, LMSW, or LCSW license Preferred:
Certification in Case Management
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