JOB
The Case Manager uses InterQual criteria to evaluate the appropriateness of admissions, concurrent stay and readiness for discharge. She/he assures the correct level of care: critical, telemetry, acute, observation, for all patients. The Case Manager provides an efficient, coordinated approach to clinical management, with an emphasis on discharge planning, care coordination and utilization management activities for select patient populations across the continuum of programs and services at GMC.
The essential functions of the Case Manager require constant collaboration with the Social Workers, Nursing staff, Financial Counselors, Medical Staff to coordinate the care of patients in a proactive manner. The position requires the full understanding and active participation in fulfilling the mission of GMC - Garfield Medical Center. It is expected that the employee demonstrates behavior consistent with the core values.
The employee shall support GMC - Garfield Medical Center strategic plan and goals and direction of the performance improvement plan. Responsibilities Creates a positive first impression. Treats all internal and external customers with dignity and respect.
Communicates compassionately and effectively by being a good listener, keeping the customer informed and meeting/exceeding their expectations. Actively seeks ways to improve level of performance/service by attending classes/seminars/on-the-job training Expresses self clearly/legibly in verbal/written communication. Demonstrates professional behavior in all interactions.
Responds to the needs/requests of others quickly and efficiently. Assists others in completing tasks or duties. Supports the Mission and Strategic Plan of the Medical Center.
Utilizes system to "acknowledge, apologize and amend" in situations where customer needs are not met. Is flexible and adaptive to changes in work processes and functions. Seeks new and creative ways of promoting the Mission of the Medical Center.
Fulfills compliance education requirements as directed by the Compliance Department or department management. Takes appropriate safety precautions in performing job function and reports industrial illness/injury per policy. Complies with Fire Safety regulations.
Complies with procedure for obtaining emergency assistance. Takes appropriate precautions in handling hazardous material. Reports hazardous spills appropriately.
Describes appropriate response to internal/external triage. Complies with the Safe Medical Device Act in management of malfunctioning equipment Demonstrates appropriate safety with use of equipment. Takes appropriate action in the event of a utilities failure.
Describes the proper way of handling and disposing of contaminated materials. Describes steps to follow in the event of a Code Pink Practices Standard Precautions in patient care activities. Utilizes methods of compliance to prevent exposure to blood-borne pathogens - example, Hepatitis B vaccine program, waste disposal, hazard communications.
Assures that care provided is consistent with known wishes of patient as documented in advance directives. Identifies types of information protected under HIPAA and complies with HIPPA regulations. Recognizes indicators and proper reporting of abuse.
Practices National Patient Safety Goals (NPSG). Utilizes appropriate methods to prevent falls/wandering. Complies with event reporting, sentinel event procedures, and hospital disclosure policies.
Complies with department performance improvement processes/activities. Performs admission and continued stay review utilizing criteria approved by the medical staff to ensure that patients meets Severity of Illness/ Intensity of Service criteria. Confers with the attending/consulting physician(s) as appropriate when the medical necessity for admission or continued stay is not clear.
Consults with the Physician Advisor when the admission or continued stay does not meet criteria, care is not being provided timely or does not meet the community standard of care. Provides clinical review information to external review entities or insurance companies to insure authorization for admission and continued stay is obtained. Accurately completes the MediCal Treatment Authorization Request (TAR) in detail to insure payment for hospital services.
Refers medically complex patients under the age of 65 to the MediCal Case Management program. Facilitates transfer of patients to other acute care facilities as required either due to third party payer requirements or county indigent program. Identifies potentially avoidable days, delays in service, over utilization or quality of care issues and completes reports as required.
Performs the Case Management Admission Assessment within two working days of admission. With the concurrence of the patient, family and physician develops a plan for post discharge care. Refers appropriate patients to Social Services for psychosocial intervention, Advance Directive or end of life education.
Accurately documents the case management process in the medical record on the Discharge Planning Assessment form N-245. Identifies the responsibilities and involvement of the Inter-disciplinary team members in discharge planning activities on an ongoing basis. Participates in Interdisciplinary Care rounds/conferences to facilitate coordination of care, goal setting, and developing strategies to facilitate the discharge planning process.
Communicates the final discharge date and plan with the patient and family to ensure that they are informed as required by law and documents such notification in the Plan section of the Discharge Planning Assessment form. (N-245) Provides accurate information and completes referrals as appropriate to implement the discharge plan including but not limited to Home Health Services, Hospice, Skilled Nursing Facilities, Durable Medical Supplies, and other community resources.
Performs other duties as assigned. Qualifications EDUCATION, EXPERIENCE, TRAINING Current California RN license required. One year Case Manager Experience required BCLS (AHA) certification required.
Certified Case Manager (Preferred) Meets education and competency requirements for the position.
Day shift