Total hours worked per week: 40
Description
SUMMARY
The Patient Care Manager facilitates progression-of-care and monitors the patient's progress to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, cost effective, and authorized by insurance companies. ENTRY REQUIREMENTS
A Bachelor's or Master's degree in Social Work - must have social work license (BSW, LLMSW, LMSW).
As a non-Nursing job in the Technical/Professional job family, this job is ineligible for participation the Nursing Clinical Advancement program.
Recent hospital patient care experience and knowledge of hospital operations preferred.
Strong interview, assessment, organizational and problem solving skills and ability to work independently.
Demonstrates priority setting and time management capabilities.
The Patient Care Manager must possess strong communication and interpersonal skills, leadership, negotiation skills, good leadership talent.
Possesses excellent communication and negotiation skills. Must demonstrate patience and tact when working with patients, families and members of the healthcare team.
Fosters positive internal and external customer relations. ORGANIZATION
Reports to the Director of the Behavioral Health Service Line or designated Behavioral Health Manager. SPECIFIC DUTIES1. Supports the Mission, Vision and Values of Munson Healthcare.2. Embraces and supports the Performance Improvement philosophy of Munson Healthcare.3. Promotes personal and patient safety.4. Uses effective customer service/interpersonal skills at all times.5. Maintains working knowledge/experience in utilization management, managed care, and payer issues that may impact the course of care.
6. Timely response to screening referrals for case management services.
7. Identifies appropriate community resources on assigned caseload and to works collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes.
8. Confirms admission diagnosis and identifies related quality/care metrics to promote medical compliance.
9. Advocates for patient by assessing those patients’ healthcare needs are being addressed in the most appropriate level of care.
10. Encourages and facilitates patient/family participation in all care and treatment decisions.
Educates members of the patient's healthcare team on the appropriate access to, and use of various levels of care.
11. Recognizes and responds appropriately to readmission or psychosocial risk factors.
12. Consults with manager or director as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels.
13. Serves as primary liaison between and among physicians, patients, families, payers, external case managers and interdisciplinary clinical team.
14. Participates in discharge planning activities for complex patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers.
15. Stays current on patient's eligibility for admission, continuing stay or readiness for discharge according to medical necessity guidelines. (InterQual criteria)
16. Reviews available documentation to assess all admissions to inpatient, Partial Hospital Program and
Residential Program for appropriate status and services according to patient condition and diagnosis. 17. Applies standard guidelines to determine appropriateness for inpatient, PHP, or Residential level of
care based on documented condition plan of treatment and care.18. Understands and applies federal law regarding the use of Hospital Initiated Notice of Non
Coverage (HINN) and Ambulatory Benefit Notice (ABN).19. Actively participates in daily huddles, patient care conferences, and hospitalist/nurses hand-off
reports to maintain knowledge about the patient’s clinical status and progression of care.20. Notifies insurers and third party administrators of clinical review information.21. Maintains documentation on each patient to include specific criteria that support appropriate
level of care and continued stay. Performs status changes as necessary.22. Collaborates with clinical team to confirm benefit eligibility for post-acute services.23. Applies Interqual/Milliman discharge screens to assess patient’s readiness for discharge.24. Updates all involved parties regarding potential, threatened or actual denials due to lack of
medical necessity or barriers to the progression of care.25. Identifies and records episodes of preventable delays or avoidable days due to failure of progression-of-care processes.
26. Participates in quality improvement activities and any other departmental research or studies as requested by the department manager.
27. Assertively manages resource utilization while appropriately navigating the patient's movement along the continuum of care.
28. Utilizes the Program Manager, Director and Medical Director as expert advisors to gain insights in dealing with physicians, clinicians, and resource management issues.
29. Works to determine patient's eligibility for post-acute services.
30. Performs other duties and responsibilities as assigned.