Centralized Case Management Specialist

Job Description Summary

Under the general supervision of the Care Progression Manager acts as a Centralized Case Management Specialist to SSH&EC clients. Works in coordination with various care partners across the System, i.e. RN Care Coordinators, Social Work, Mobile Integrated Health, Emergency department, Urgent and Ambulatory Care centers, to coordinate service or resources as routed to the Centralized Case Management Office. This position will directly support care management and care coordination to facilitate achievement of quality and cost-efficient patient outcomes. The Centralized Case Management Specialist will provide exceptional customer service while demonstrating call control and maintaining a high level of professionalism with each interaction. Responds to all inquiries, facilitates the scheduling of appointments when appropriate, assists the care coordination clinical team with connecting patients and families to appropriate community resources, coordinating referrals to system and community programs. Facilitate the setup of ordered DME and/or home equipment to foster management of patients in the community when appropriate. Creates referrals to post-acute facilities and Homecare as directed by the RN Case Manager and Social Worker for discharge planning.

Job Description

ESSENTIAL FUNCTIONS

1.) Customer Service:

a. Greets and acknowledges all patients and families in person or via telephone, with professionalism and directs to appropriate services.

b. Acts as a positive role model to other staff, encouraging others to interact with customers, engage in conversation and express interest

c. Proactively greets customers by name and with individualized interest

d. Follows through on messages to be sure to keep entire team informed of issues as needed

e. Independently initiates and follows through with service recovery process while keeping all team members informed as needed

f. Monitors call flow throughout the day frequently keeping manager informed of delays or issues as needed

g. Fosters a pleasant and professional office environment in keeping with Culture of Service Excellence standards

h. Answers telephones by the third ring, using department accepted greeting and in professional tone in accordance with the hospital’s telephone etiquette standards

i. Checks phone messages each hour and responds to call within same business day

2)  Patient Interaction:

a. Staff will work to enhance the patient experience in every interaction.

b. Demonstrates professional courtesy in all interactions with patients, family, coworkers and referral entities.

c. Answers all questions in a polite, professional manner or finds someone who can answer the question.

d. Able to handle difficult patients or situations in a calm, professional manner.

f.  Able to report issues/concerns using the chain of command.

3) Work under the guidance / direction of clinical care team members to coordinate and facilitate care   coordination and transitional care interventions for South Shore Health populations.

a. Conduct outreach calls.

b. Document activities via patient outreach.

c. Arrange transportation

d. Escalates any patient questions and / or concerns to the RN Case Manager as need arises.

e. Escalate any provider concerns related to payer issues, or clinical concern to the RN Case Manager or Manager of Transitional Care.

4) Under the direction of the RN Case Manager, Social Worker or Case Manager Specialist creates select referrals for the patient’s Post-Acute Care needs

a. Speaks with Care Progression staff about proposed plan.

b. Meets with patient and or designated contact to offer patient choice for Post-Acute vendors.

c. Create referral for Post-Acute Acute Rehab, Skilled Nursing Facility, Homecare or other post-acute vendor.

d. Communicate with Post-Acute vendor obtaining acceptance or denial of patient’s care and communicating this to the RN Case Manger or Clinical Social Worker.

e. May communicate with patient or designated contact under partnership with the RN Case Manager, Social Worker or Case Manager Specialist to obtain final decision of vendor selection.

f. Clearly document in the electronic medical record the referral being sent and any communication with the Post-Acute vendor for availability to review by the clinical team.

5) Acts as a communication liaison between all members of the care team and the patient/family as it may pertain to care coordination, concerns and barriers.

a. Maintains up to date communication with whole team.

b. Maintain up to date documentation reflective of changes who, and why the changes were made in EMR.

c. Uses SBAR to communicate with peers.

d. Communicates effectively with closed loop communication techniques, always maintaining professional, polite and collegial tone and word choice.

6) Maintain current working knowledge of resources available to client’s served via awareness of provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO

a. Maintains current knowledge of care coordination resources within South Shore Health System.

b. Maintains a working knowledge of the resources available in the community.  

c. Maintains a working knowledge of the requirements of the payers most frequently seen.

d. Maintains a working knowledge of the established and preferred ACO relationships as defined in service area.

7) Is responsible for department operational excellence, regarding safe and effective care management; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.

a. Manages all activities so that quality services are provided in an efficient and effective manner.

b. Participates in departmental and organizational Quality Improvement initiatives involving the Lean principles.

c. Follows department policies, procedures, and standards of care that support operational excellence and productivity measurements.

8) Works independently to complete daily assignments by the end of the shift and long-term assignments by established deadline.

a. Efficiently manages work schedule to accomplish assignments and activities before deadline.

b. Works independently with infrequent need for supervision

c. Informs supervisor when not able to meet deadline.

d. Ability to connect with people and understand the challenges they face.

9) Safety Awareness – Foster a “Culture of Safety” through personal ownership and commitment to a safe environment.

a. Verifies the patient using two unique identifiers.

b. Complies with the current CDC hand hygiene guidelines through proper handwashing, as observed by the nurse manager and peers.

c. Makes appropriate use of personal protective equipment at all times.

d. Adheres to universal precautions.

10) Professional Development

a. Assumes overall responsibility for professional development by incorporating evidenced-based practice, research, and performance improvement initiatives as a part of ongoing practice.

11) Technology and Learning

a. Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization. b. Embraces technological advances that allow us to communicate information effectively and efficiently   based on role.

c. Able to navigate multiple technology platforms to support work; to include Epic Clin Doc, Ambulatory Healthy Planet module, Epic Care Link, My Chart, Patient Ping, Arcadia, Tiger Connect, Zoom, Jabber and Outlook.

d. Must have a smartphone mobile device available for business use which can support Tiger Connect communications at all times during workday.

e. Demonstrated competency in basic computer and keyboard skills required, Microsoft Office, Outlook, EPIC preferred.  Knowledge of basic medical terminology preferred, or completion of course within first 6 months of hire.                                                     

JOB REQUIREMENTS

Minimum Education - Preferred

BS in Psychology, Social Work, Communications or health related field preferred.

Minimum Work Experience

3-5 years recent healthcare experience or related field preferred. Experience working with patients and families, elders and their caregivers, and/or various other community populations desirable. Knowledge of community resources, eligibility and referral processes. Experience working with patients and families over the phone. Experience working in a team atmosphere.

Required additional Knowledge and Abilities

Excellent communication skills required; ability to work independently and at times under stressful situations required. Ability to problem solve and follow standard workflow protocols as directed by clinical lead.  Strong customer service skills both in person and by telephone required. Ability to time manage, set priorities and self-organization will be essential to success of employee.  Ability to work collaboratively within a multidisciplinary team adhering to the Pillars of Excellence required. Experience working with patients with chronic health needs and their families required. Demonstrated competency in basic computer and keyboard skills required.  Knowledge of basic medical terminology preferred, or completion of course within first year of hire. Demonstrated success in working as part of a multi-disciplinary team including communicating and working with Patients, Families, Physicians, Registered Nurses, Care Managers, Social Workers, and other care team members.