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Healthcare Patient Services Manager

2 months ago


Cadillac, Michigan, United States Munson Healthcare Full time

Requisition #: 60325

Total hours worked per week: 24-40

DESCRIPTION

SUMMARY


The Patient Care Manager plays a pivotal role in overseeing the continuum of care, ensuring that patient progress aligns with the established care plan. This position is dedicated to delivering patient-centered, high-quality, evidence-based services that are tailored to individual needs while maintaining efficiency and cost-effectiveness.


ELIGIBILITY REQUIREMENTS

A Bachelor's or Master's Degree in Social Work is required.

Preference will be given to candidates with an MSW. Limited licensure may be considered.

Applicants must possess a minimum of 3 years of recent patient care experience along with a solid understanding of hospital operations.

Strong skills in interviewing, assessment, organization, and problem-solving are essential, along with the ability to work independently.

Demonstrated skills in prioritization and time management are crucial.

Familiarity with the Case Management Society of America's standards of practice is expected.

Eligible candidates should be prepared to sit for and successfully complete the certification exam for Certified Case Manager (CCM) or Accredited Case Manager (ACM) within two years of employment.

The Patient Care Manager must exhibit exceptional communication and interpersonal skills, along with strong leadership and negotiation abilities.

Effective communication and negotiation skills are vital. Patience and tact are necessary when interacting with patients, families, and healthcare team members.

This role fosters positive relationships with both internal and external customers.

SPECIFIC DUTIES

  • Uphold the Mission, Vision, and Values of Munson Healthcare.
  • Support the Performance Improvement philosophy of the organization.
  • Advocate for personal and patient safety.
  • Possess a foundational understanding of Relationship-Based Care (RBC) principles and fulfill expectations outlined in Commitment To My Co-workers, while supporting RBC unit action plans.
  • Utilize effective customer service and interpersonal skills consistently.
  • Maintain knowledge and experience in utilization management, managed care, and payer issues that may influence care pathways.
  • Respond promptly to screening referrals for case management services.
  • Identify suitable community resources for assigned cases and collaborate with patients, families, multidisciplinary teams, and community agencies to achieve optimal patient outcomes.
  • Verify admission diagnoses and recognize related quality/care metrics to enhance medical compliance.
  • Advocate for patients by ensuring their healthcare needs are met at the most appropriate level of care.
  • Encourage and facilitate patient and family involvement in all care and treatment decisions.
  • Educate healthcare team members on appropriate access to and utilization of various levels of care.
  • Identify patients at risk for readmission and refer them for community-based follow-up.
  • Recognize and appropriately respond to readmission or psychosocial risk factors.
  • Consult with physician advisors as needed to address barriers to progression of care through appropriate administrative and medical channels.
  • Act as the primary liaison among physicians, patients, families, payers, external case managers, and the interdisciplinary clinical team.
  • Engage in discharge planning activities for complex patients to ensure timely discharges and appropriate connections with post-discharge care providers, referring suitable cases to the Complex Discharge planner.
  • Collaborate with Post-Acute Coordinators to monitor and facilitate the completion of complex post-acute services.
  • Interface with utilization review specialists to remain informed about patients' eligibility for admission, continued stay, or readiness for discharge according to medical necessity guidelines (InterQual criteria).
  • Persist in efforts to influence clinical and financial outcomes of care.
  • Identify and document instances of preventable delays or avoidable days resulting from failures in progression-of-care processes.
  • Participate in quality improvement initiatives and any departmental research or studies as requested by management.
  • Effectively manage resource utilization while guiding patients along the continuum of care.
  • Collaborate with social workers, counselors, and Resource Center coordinators to explore discharge placement options when home discharge is not feasible, focusing on patient/family goals, interdisciplinary team recommendations, available payer benefits, and financial considerations that may affect placement.
  • Utilize the expertise of the Program Manager, Director, and Medical Advisor to gain insights into physician and Resource Management issues.
  • Work with the resource center and providers to determine patients' eligibility for post-acute services.
  • May assist in the training and orientation of new department staff and students.
  • Perform other duties and responsibilities as assigned.