Clinical Case Manager
2 months ago
General Summary of Position
MedStar Health is looking for a Clinical Case Manager to join our team
The Clinical Case Manager monitors the care and services delivered to selected patient populations during the acute hospital stay, promotes effective utilization of resources, and assumes a leadership role with the interdisciplinary team to achieve optimal clinical and resource outcomes for the acute, and posthospital phases of care. Develops and maintains a positive work climate and supports the overall team effort of the health system. The functions are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital's philosophy, policies, procedures, and standards.
Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move
Primary Duties:
- Assesses, facilitates, and monitors the care plan with the patient and/or family/significant other. Communicates the need, or lack of, continued hospitalization and ensures patient understanding of third-party payer guidelines.
- Conducts concurrent chart review of selected patient populations, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and completeness of medical record documentation.
- Reviews all patient admission data within the designated times to determine the suitability of the level of care in accordance with established guidelines. Identifies issues/problems and makes appropriate recommendations. Communicates with patients, families/ significant others, medical staff, caregivers, and third-party payers, as necessary.
- Coordinates care within MGUH (MedStar Georgetown University Hospital) and other settings by monitoring and overseeing the continuum of clinical care, ensuring necessary meetings are held with patient/family and the interdisciplinary team to coordinate treatment and discharge plans. Arranges discharge-planning referrals as ordered by patient's physician.
- Serves as a facilitator/advocate for patients and families in the resolution of problems related to the established plan of care and procurement of services. Produces case documentation in approved manual or electronic format while maintaining required departmental standards and protocols. Participates in the development and standardization of improved pathway and best practice scenarios.
Qualifications:
- Master's degree in social work or bachelor's degree in nursing.
- 3-4 years Clinical experience in an acute care setting.
- RN (Registered Nurse) State Licensure and/or Compact State Licensure or LCSW in the District of Columbia.
- Specialty certification preferred.
- Advanced Degree preferred.
- Utilization management and/or case management experience preferred.
Primary Duties and Responsibilities
Minimum Qualifications
This position has a hiring range of $ $
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