Under the general supervision of the Case Management Director, acts as a patient advocate/ Case Manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost effective patient outcomes.
Knowledge of and works within the CMS Conditions of Participation for Discharge planning
Timely assessment of patients identified with discharge planning needs
Development and implementation of discharge plans for each patient targeting optimal cost and quality outcomes
Re-evaluation for discharge needs upon change of condition of the patient or caregiver ability to care for the patient
Maximizes care coordination efforts and collaborates with the healthcare team to promote efficient movement through the continuum of care
Identifies and mitigates delays in delivery of care
Effective and appropriate communication with the healthcare team, patient, and family
Timely, appropriate, and accurate documentation of the discharge plan, patient progress to plan, and communication with the healthcare team, patient, and family in the medical record
Assists the Director of Case Management with collection of data for the UM Committee and other reports
Escalates cases appropriately
As required, collaborates with payers to ensure authorization for discharge plan needs
Participates in Interdisciplinary Rounds
Displays effective communication skills
Assists the Director of Case Management with other job duties as requested
Demonstrates knowledge of HIPAA guidelines and utilizes them in all aspects of communicationQualifications
Education: Associates Degree in Nursing required. Bachelors Degree in Nursing desirable. The Registered Nurse must possess a license to practice in the state of Georgia.
Experience: 5 or more years in the acute care setting. Experience in other related healthcare settings considered. Previous case management experience desirable, but not required.