Case Manager Community Access-Care Management - MetroHealth
Cleveland, OH
About the Job
Location: METROHEALTH MEDICAL CENTER
Biweekly Hours: 80.00
Shift: 8:00am - 6:30pm
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Coordinates the discharge plan for patients requiring case management involvement within the Emergency Department/Clinical Decision Unit, and in accordance with established clinical standards and guidelines. Assesses patients for potential case management intervention. Interacts with third party payers, external case managers, post-acute service providers, and the interdisciplinary team throughout the case management process. Negotiates benefits and care plans between the patient, the interdisciplinary team, the patients' family, and payers. Monitors the effectiveness of the care plan and patient/third party payer satisfaction. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.
Qualifications:
Required: Bachelors of Science in Nursing (BSN) degree from an accredited institution. Currently possess a Registered Nurse (RN) license through the State of Ohio Board of Nursing. 3 years of experience in one or more of the following areas: Medical/Surgical, Intensive Care Unit (ICU), or Long-Term Acute Care (LTAC). Ability to work independently and as a member of an interdisciplinary team. Effective written, verbal, and interpersonal communication skills. Effective organizational skills. Solid clinical reasoning skills. Ability to prioritize tasks and multitask efficiently. Basic proficiency with computers and computer software. Proven history of on-going professional development in a nursing specialty and/or case management within the past 12 months via either current continuing education certificates or a letter from an accredited academic program. Preferred: Masters of Science in Nursing (MSN) degree from an accredited institution. Possess an accepted Case Management Certification from a recognized issuing organization (i.e. a Certified Case Manager (CCM) credential from the Commission for Case Manager Certification (CCMC)). 2 years of experience in one or more of the following areas: Case Management, Discharge Planning, Long Term Acute Care, Home Care, or Care Coordination. Knowledge of/experience with applying common sets of medical necessity criteria for inpatient care (i.e. InterQual or Milliman). Experience in a clinical environment. Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to communicate in face-to-face, phone, email, and other communications. Ability to see computer monitor and departmental documents. Requires some exposure to communicable diseases or body fluids. Requires some exposure to chemicals.
Biweekly Hours: 80.00
Shift: 8:00am - 6:30pm
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Coordinates the discharge plan for patients requiring case management involvement within the Emergency Department/Clinical Decision Unit, and in accordance with established clinical standards and guidelines. Assesses patients for potential case management intervention. Interacts with third party payers, external case managers, post-acute service providers, and the interdisciplinary team throughout the case management process. Negotiates benefits and care plans between the patient, the interdisciplinary team, the patients' family, and payers. Monitors the effectiveness of the care plan and patient/third party payer satisfaction. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.
Qualifications:
Required: Bachelors of Science in Nursing (BSN) degree from an accredited institution. Currently possess a Registered Nurse (RN) license through the State of Ohio Board of Nursing. 3 years of experience in one or more of the following areas: Medical/Surgical, Intensive Care Unit (ICU), or Long-Term Acute Care (LTAC). Ability to work independently and as a member of an interdisciplinary team. Effective written, verbal, and interpersonal communication skills. Effective organizational skills. Solid clinical reasoning skills. Ability to prioritize tasks and multitask efficiently. Basic proficiency with computers and computer software. Proven history of on-going professional development in a nursing specialty and/or case management within the past 12 months via either current continuing education certificates or a letter from an accredited academic program. Preferred: Masters of Science in Nursing (MSN) degree from an accredited institution. Possess an accepted Case Management Certification from a recognized issuing organization (i.e. a Certified Case Manager (CCM) credential from the Commission for Case Manager Certification (CCMC)). 2 years of experience in one or more of the following areas: Case Management, Discharge Planning, Long Term Acute Care, Home Care, or Care Coordination. Knowledge of/experience with applying common sets of medical necessity criteria for inpatient care (i.e. InterQual or Milliman). Experience in a clinical environment. Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to communicate in face-to-face, phone, email, and other communications. Ability to see computer monitor and departmental documents. Requires some exposure to communicable diseases or body fluids. Requires some exposure to chemicals.
Source : MetroHealth