Case Manager
Company: Aurora Healthcare
Location: sheboygan
Posted on: May 3, 2021
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Job Description:
Works to enhance the effective utilization of organizational
resources to assist the Medical Center in achieving its goals of
high quality, cost-effective patient care and service, and for
continuity of care across the continuum. Demonstrates compliance
with external regulatory agency standards. Conducts complete assessments, establishes appropriate plans,
and initiates interventions within desired timeframes. Collaborates
and negotiates effectively with patient, family, and team while
striving to achieve patient and organizational goals with regard to
patients care needs, choice and satisfaction when discharge
planning/transitioning care. Utilizes patient/family strengths in
the problem solving process, involving the patient/family and team
in the decision making process beginning on admission and
continuing throughout patients hospital stay. Provides continuity of care and discharge planning services
compliant with regulatory standards by providing coordinated
relevant options and services based on assessed needs to ensure
patient/family and healthcare team is informed and able to proceed
with accountabilities in a timely manner. This includes
participating in the communication process to facilitate a smooth
transition for patient, family, and staff when patients are
transferred. Provides case management services related to various levels of
health care, finances, housing, family discord, or illness
adjustment, based department scope. This may include managing
family dynamics and crisis situations in a timely and professional
manner, using community resources effectively, and educating
patient/family regarding access to and use of services. Documents discharge planning interventions and utilization
review activity per department and medical center standards in a
timely manner. Performs and documents accurate and timely
concurrent and retrospective reviews based on approved established
criteria. Communicates effectively with the healthcare team. Serves as an
active member of the Outcome Facilitation Team/Multidisciplinary
Team and works closely with medical staff, hospital departments and
ancillary services in identification and resolution of barriers to
discharge, expediting care delivery to avoid delays in timely
service provision, and implementing and reporting utilization
management (UM) activities. Collaborates with managers, physicians, medical directors,
advisory groups and treatment teams for issues related to physician
practices and best practices for the patients plan of care. Refers
cases to physician advisor as needed to ensure accurate status and
compliance with regulatory guidelines. Remains knowledgeable in issues of healthcare regulations,
reimbursement issues, impact on length of stay and community
resources. Provides clinical updates to payers and/or external
review organizations, collects data, coordinates denial activity,
supports UM activity, and manages avoidable delays. Delivers CMS
regulatory notices within CMS established timeframes, as
appropriate based on site guidelines. Develops and maintains productive relationships with
community-based agencies and networks by representing Aurora Health
Care in a positive manner working collaboratively, internally and
externally, to meet patient/family needs. Serves as an educator and expert resource to medical and
hospital staff regarding admission status and acute care criteria,
utilization management issues and relevant regulatory
requirements. .8 FTE Flexible schedule M-F, 1st shift hours Every 5th Saturday is required Licenses & Certifications Registered Nurse license issued by the state in which the team
member practices. Degrees Bachelor's Degree (or equivalent knowledge) in Nursing. Required Functional Experience Typically requires 3 years of experience in clinical
nursing. Knowledge, Skills & Abilities Must have working knowledge in the use of Microsoft Office
(Excel, Outlook, PowerPoint and Word) or similar productsKnowledge
of the components of quality and acute patient care needs
specifically related to the area/function in which care management
will be performed.Demonstrates working knowledge of Utilization
Review criteria as demonstrated by achieving 80% or greater on the
annual InterRater Reliability (IRR) competency exam.Utilizes
critical thinking skills to analyze and synthesize clinical
scenarios as it relates to application of medical necessity
criteria. Excellent analytical and Interpersonal communication
skills necessary to interact with families, patient, physicians and
third party payers. Ability to manage conflict appropriately,
seeking a win-win outcome by communicating issues in accordance
with the Aurora Service commitments.Promotes effective professional
relationships with physicians and other professionals in a direct
and positive manner.Takes responsibility for self-development by
seeking out opportunities for professional growth and development
and being an active participant in department, hospital, and system
initiatives.
Keywords: Aurora Healthcare, Sheboygan , Case Manager, Other , sheboygan, Wisconsin
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