Mission Community Hospital has a 50 year legacy of serving the San Fernando Valley with compassionate care. We currently seek an RN or LVN for our Case Management group
Reporting directly to the Director of Case Management Services, Supervisor of Case Management/Lead Discharge Planner. The discharge planner/case manager will perform initial assessments with 24 hours of admissions, reassessments for inpatients greater than 4-days, utilization reviews, initial, concurrent and retrospective reviews utilizing Evidence Based Medicine Criteria. The utilization review processes are applicable to all inpatient’s and observation patient that are hospitalized on any acute care unit as well in the emergency department. Discharge planning shall be performed on all patients to assure safe discharges and any patient’s specific needs to include any other related case management/ discharge planning services. Awareness of services available to patients and their families are an important part of this assessment. Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the discharge planner/case manager will contact the appropriate agency to meet the patient’s social, emotional and spiritual needs.
MAJOR RESPONSIBILITIES
ole of case manager/ discharge planner The essential functions and components of the Discharge Planner role include:
1. Ensure to discharge patients within 3-hours of a discharge order given.
2. Performs EMB utilization review (UR) criteria screens for all patients and formulates discharge plans within 24 hours of admission.
3. Proactively call/fax daily initial, concurrent, retrospective chart reviews to all patients regardless of payer source. Documentation in the medical record initial clinical reviews, concurrent clinical review, preadmission reviews to take place in the emergency department and any retrospective reviews that as assigned to the discharge planner/case manager. Documentation in the medical record that reviews was called/faxed with documentation of the call and/or fax, the outcome of the review.
4. Respond to all payers or payor groups within 24 hours of receiving notice when initial, concurrent or retrospective patient care reviews are requested.
5. Independently performs timely retrospective chart reviews on all assigned patient’s utilizing approved EBM hospital criteria: Initiate reviews on all patient (s) regardless of payer source within 24 hours working day of patient’s admissions.
6. When patient fails to meet inpatient or observation medical necessity or has a noted medical management issues the case manager/discharge planner shall contact attending responsible physicians who failed to meet level of care criteria. For all medical management issues the discharge planner/case manager shall endorse to director of case management who will endorse to physician advisor and/or medical; director when indicated.
7. Document the medical necessity utilizing EBM criteria and expected next review date of next UR review should be called/faxed as indicated by payor and should be documented in the medical records.
8. Obtains authorizations as required by payors for patient’s who requires authorizations.
9. Facilitates transfer of patients to other acute care facilities that are capitated to another faculty or county mandated indigent program that require transferring.
10. Maintains accurate records of all activities relating to the utilization, case management/ discharge planning.
11. Maintain working knowledge of state and federal regulations and provider requirements, governing coverage of inpatient services, observation services, i.e., Medicare, Medi-Genetically and Handicapped Programs, IHSS available to patients to include and other available patient resources.
12. Interviews patients and families to obtain relevant information and develops discharge plan with input which may require from other members of the health care team.
13. Provides information and makes referrals as appropriate to implement the plan such as community resources, home health care, institutional placements, financial assistance, equipment needs, and catastrophic case management by payors.
14. Identifies situations needing psychosocial intervention and promptly refers them to Social Services.
15. Maintains accurate and through documentation of discharge planning activities to include those mandated by third party payors. Record case management/discharge planning information in the medical record in a timely manner.
16. Works collaboratively with the nursing staff and other disciplines to support and achieve the goals of the collaborative care process.
17. Handles all information obtained through the above process with utmost confidentiality to observe HIPPA regulator standards.
18. Works closely with other members of the health care team to facilitate the above process.
19. Maintains objectivity and good interpersonal skills, which allow for effective interaction with a wide variety of people.
20. Participates in staff interdisciplinary meetings, committee meetings, team conference and other activities as assigned.
21. Maintains accurate and updated review notes/records of payor UR activities as required.
22. Identifies and refers situations requiring immediate intervention to Risk Management/QI Director as indicated.
23. Participates in the orientation of new employees or cross training of other discharge planners as needed.
24. Participates in mandatory UR/CM/DP staff education or hospital in-services.
25. Participates in department quality improvement programs/projects/audits.
26. Demonstrates an understanding of Mission Community Hospital’s vision, Mission and Guiding Principles, and incorporates them into daily performance.
27. Proactively seeks team-building and positive working relationships with hospital staff physicians, Physician Assistances, Nurse Practitioners.
28. Demonstrates a continuing effort to improve the quality of his/her performance to better the Organization.
29. Performs other related duties as assigned. 30. The above statements reflect the essential functions considered necessary to describe the principle content of the job. They are not intended to be a complete statement of all work requirements or duties that may be inherent in the job.
QUALIFICATIONS
1. Licensed Nurse (RN) ) or LVN and a graduate of an accredited school of professional nursing and a current license with the California State Nursing Board.
2. Non-nurse with related field BS degree preferred.
3. Ability to interact with patients, families, physicians, ancillary services and community community resources and supportive agencies.
4. Ability to maintain confidentiality of PHI
5. Efficient level of organizational skills.
6. Proficient frontline communication skills.
7. Demonstrated Case Management /Discharge Planning Competencies.
8. Demonstrated written/verbal communication skills.
9. Proficient in computer operations using Microsoft and Excel and EBM software.