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Case Manager, Full Time, Days
2 months ago
The Clinical Coordinator plays a vital role in the healthcare team, ensuring that patients receive the most appropriate and cost-effective care. This position requires strong clinical expertise and the ability to work collaboratively with physicians, nurses, and other healthcare professionals to coordinate patient care.
Key Responsibilities- Assess patients on admission to identify discharge planning needs and document the assessment in the patient's medical record.
- Contribute to the development of the patient's interdisciplinary plan of care, ensuring that it aligns with the discharge plan and the patient's ongoing care needs.
- Screen patients for discharge planning needs and refer those with complex needs to the social worker.
- Use established criteria to assess patients for appropriateness of admission, need for continued stay, and take appropriate action to ensure correct patient status.
- Communicate with external review agencies and the business office regarding concurrent patient review and insurance contracts.
- Discuss with attending physicians the appropriateness of admission, continued stay, resource utilization, consultations, estimated length of stay, and discharge plan.
- Refer cases to the Physician Advisor as needed.
- Participate in interdisciplinary patient meetings to coordinate the elimination of barriers to efficient delivery of care in the appropriate setting.
- Coordinate activities to ensure patient appeal rights under the discharge appeal program.
- Ensure that patients receive Important Message from Medicare as required upon admission and discharge.
- Maintain accurate and consistent chart documentation, meeting department and organizational standards.
- Document reviews and findings on appropriate paperwork and/or software.
- Stay current with federal and state regulations regarding Medicare, Medicaid, Champus, and other government agencies in healthcare.
- Maintain clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities.
- Participate in the quality improvement process for the Case Management Department.
- Attend Department and Team staff meetings, with a minimum attendance of ¾ of scheduled meetings.
- Perform additional duties as assigned.
To be successful in this role, the ideal candidate will possess:
- A graduate degree in Nursing from an accredited institution, with current licensure in Alabama.
- Three years of clinical experience, with a comparable combination of education and experience also considered.
- Previous experience in utilization management, discharge planning, or hospital-based social services is highly beneficial.
- Excellent communication and organizational skills, with the ability to work effectively in a fast-paced environment.
