Patient Care Resource Coordinator
2 months ago
Job Overview:
The Resource Case Manager acts as a pivotal authority in case management, providing operational insight within the case management divisions across various Kindred hospitals. This role is essential in orchestrating and streamlining the care of patients through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. The Resource Case Manager also serves as a mentor and guide to staff, delivering educational support related to resource management, discharge planning, and the psychosocial dimensions of healthcare delivery. This position follows patients throughout their care journey, ensuring optimal resource utilization, service delivery, and adherence to external review standards. Continuous support and expertise are provided through thorough assessments, care planning, implementation of plans, and overall evaluation of individual patient requirements. The role enhances patient management quality and satisfaction, promoting continuity of care and cost efficiency by integrating case management, utilization review, and discharge planning functions. Collaboration with external stakeholders, referral sources, and payors is vital to facilitate and coordinate the discharge planning process while advocating for patients and their families.Key Responsibilities:
Care Coordination
Acts as a key expert in the daily management of patient care to support the development, monitoring, and refinement of treatment plans. Collaborates with the Director of Case Management to ensure compliance with CMS, State, and JCAHO regulations and Kindred policies, including documentation and record-keeping requirements. Engages actively in surveys and audits. Coordinates clinical and psychosocial activities with the Interdisciplinary Team and Physicians. Monitors all aspects of patients' care to ensure effective coordination and efficient facilitation. Maintains up-to-date knowledge regarding reimbursement practices, community resources, case management, and legal issues affecting patients and care providers. Appropriately identifies high-risk patients who may require additional support. Serves as an advocate for patients, fostering a collaborative relationship to empower patients and families in making informed decisions. Demonstrates understanding of growth and development principles across the lifespan, ensuring age-appropriate care for the patient population served. Participates in interdisciplinary patient care rounds and conferences to review treatment objectives, optimize resource utilization, and educate patients and families on post-hospital needs. Collaborates with clinical staff in the development and execution of care plans and achievement of goals. Coordinates with the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in planning patient care throughout the continuum.Discharge Planning
Conducts comprehensive and ongoing assessments of patients to facilitate timely and safe discharge planning. Develops and executes thorough discharge plans for each patient, utilizing critical thinking skills. Ensures effective communication with patients and families throughout the discharge process.Utilization Management
Performs medical necessity reviews to ensure appropriate utilization of services from admission to discharge. Promotes effective and efficient use of clinical resources. Conducts timely and accurate clinical reviews, coordinating continued stay authorizations with payors. QualificationsEducation:
Graduate of an accredited program required:
RN, BSN preferredOR
Master of Social Work with licensure as mandated by state regulations;OR
Bachelor of Social Work with licensure as mandated by state regulationsLicenses/Certification:
Healthcare professional licensure required as Registered Nurse or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) as required by state regulations. Certification in Case Management preferred.Experience:
Minimum of two years of experience in a healthcare setting preferred, ideally in acute or LTACH. Prior experience in case management, utilization review, or discharge planning is preferred.Knowledge/Skills/Abilities/Expectations:
Understanding of government and non-government payor practices, regulations, standards, and reimbursement. Familiarity with Medicare benefits and insurance processes and contracts. Knowledge of accreditation standards and compliance requirements.-
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