The individual in this position has overall responsibility for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.
The individual's responsibilities will include, but not be limited to the following activities: a) medical necessity screening b) care coordination c) discharge planning d) facilitating multi-disciplinary patient care conferences e) managing concurrent disputes f) making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST) g ) referring complex social issues to Social Service h ) communicating with patients and their families about the plan of care i) collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy) j) participating in weekly Complex Case Review k) arranging for post -discharge patient education l) clear, complete and concise documentation in eCCM m ) maintaining accuracy of patient demographic and insurance information n) identifying and documenting potentially avoidable days o) identifying and reporting over and under utilization o) and other duties as assigned.
Attends hospital workshop led by the Director of Case Management or designee that includes the Tenet Case Management Model, InterQual, Discharge Planning, Utilization Management, and other topics specific to case management. Extended orientation with selected Case Managers may occur.
Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements
Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, Hospital specific Clinical Software
Current California RN license
Minimum 5 years bedside experience or clinical specialty (e.g., case manager for pediatrics patients should have pediatric nursing experience)
Excellent organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people
Demonstrated critical thinking and problem solving skills
Case Managers hired prior to August 2009 are grandfathered in with the same performance expectations.
Job : Case Management/Home Health
Primary Location : CA-Palm Springs
Hospital/Facility : 694-Desert Regional Medical Center - Palm Springs, CA
Job Type : Full-time
Shift Type : Days