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Nurse Case Manager (AYA MSP)

Company: PRIDE Health
Location: Springfield
Posted on: February 15, 2020

Job Description:

TWO Case Managers Needed - Springfield, MA Details: *$2,600 weekly gross *13 weeks *40 hrs/week *8:00am - 4:30pm Requirements: *Three to five (3-5) years Case Management experience, hospital or community based * CCM and ACM certifications preferred *Previous supervisory experience strongly preferred Job Description: Responsible for providing direction and leadership to Discharge Planners and Care Coordination Assistants for patient progression and care coordination. In collaboration with other internal and external disciplines, the Inpatient Care Coordinator directs and coordinates the care of patients from admission to transfer or discharge. This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses for patients, providing appropriate utilization of resources and patient advocacy. PRIMARY JOB RESPONSIBILITIES AND DUTIES 1. Provides supervision and direction to the Discharge Planner(s) and Care Coordination Assistant(s) in the prioritization of patient care and patient progression. 2. Within 24 hours of admission uses discretion and independent clinical judgment in applying evidence-based criteria as well as Medicare regulations to coordinate and direct level of care and status determination on every assigned patient. 3. Within 24 hours of admission initiates discharge planning assessment by interviewing the patient and or family to determine the patient's discharge needs and documenting the assessment. Delegates patients and families with complex psychosocial financial and legal needs to the discharge planner. Coordinates the plan and provides oversight to the Discharge Planner. 4. Collaborates with the Care Coordination Manager on the hiring corrective action evaluation processes and performance appraisals for the Discharge Planners and Care Coordination Assistants as well as employee relations issues/concerns. Collaborates with Manager in developing goals and maintaining regulatory compliance. 5. Works with Quality to make referrals investigate complaints and make recommendations to the quality department that may include Corrective Action. Works with Quality to develop and implement/mandate training or other process changes as needed. 6. Has an understanding of patients clinical trajectory and disease process and is able to report the clinical milestones that support the patient's continued need for acute care. 7. Responds to third-party payer requests for concurrent clinical information to ensure continued stay authorizations. 8. Coordinates and facilitates the multidisciplinary team and rounds on every patient every day discussing the patient care goals and discharge plan on the assigned patients. 9. Communicates pertinent information to the appropriate members of the multidisciplinary care team both effectively and professionally. 10. Identifies discharge needs problem solves and coordinates care to ensure the patient's discharge plan is consistent with their clinical course continuing care needs and covered services. Ensures safe and seamless patient transition across the continuum to prevent readmission. 11. Ensures timely completion of all discharge transfer and referral forms and educates patients on their appeal rights. 12. Advocates for patient legal social and ethical rights while balancing patient resources and hospital financial stewardship. 13. Understands risk contracts and is able to align BPCI/Tufts efforts with patient satisfaction outcomes. 14. Proactively identifies and works on barriers that impede the progression of care. Ensures the delivery of quality patient care refers quality issues and poor utilization of services to the appropriate sources and documents avoidable days/delays in care. 15. In collaboration with Care Coordination Manager responsible/accountable for professional development of Discharge Planners and Care Coordination Assistants. Maintains licensure for self and takes ownership for self-education. 16. Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities and educates hospital staff as needed. 17. Provides professional consultation to the patients and family staff and employees regarding patient stay options financial considerations psycho social concerns risk management and ethical issues. 18. Maintains absolute adherence to hospital and departmental policies and practices regarding confidentiality and patients' rights and demonstrates knowledge and support of the hospital's missions and values. 19. Communicates professionally with all internal and external customers to effectively manage all cases per established organizational standards.

Keywords: PRIDE Health, Springfield , Nurse Case Manager (AYA MSP), Healthcare , Springfield, Massachusetts

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