Case Manager D-RN - Westchester Medical Center

Summary of Job Purpose

• Case Manager coordinates care and service of selected patients across the health care continuum. Promotes effective utilization of resources and the highest quality of care for optimal clinical and resources outcomes. Ensures appropriate lengths of stay based on medical necessity. Assesses and implements effective discharge planning through identification of appropriate services and facilities across the continuum of care. Assumes a leadership and communication role with the patient/family, interdisciplinary team members, and providers of appropriate services across the continuum. Provides ongoing monitoring and evaluation of the plan across the continuum as appropriate.

Essential Job Responsibilities

• Providing interpretation and support for those who are awaiting placement for nursing home or physical rehabilitation.
• Appropriate counseling and referrals for treatment of alcohol abuse, drug abuse, child abuse, domestic violence and other mental health issues.
• Serves as Patient Advocate
• Serves as Hospice Liaison
• Discharge planning, implementation and serves as a liaison between hospital and all community agencies and institutions who are interested in the well being of patients;
• Assessment of patients taking into account age, specific service needs, having to focus on infants, children, adolescents, adult and elderly. Assessment addresses stages of growth and development, emotional cognitive, educational, social and daily activity needs as it relates to hospital stay and discharge planning.
• Helping patients and families get information and services to meet special needs not provided by hospital, or that will be needed after discharge planning in an institutional or non institutional setting.
• Locating community and other local resources which are available to patients in the hospital and after discharge.
• Developing and implementing appropriate and well coordinated referral procedures with these resources.
• Following through on such referrals to ensure that necessary treatment plans have been implemented.
• Assisting patients and community members with HCP
• Assists in continuous QI
• Swing bed Coordinator
• Interprets, supports, and recommends Swing Bed policies and procedures
• Covers UR as needed and attend UR meetings
• Inservice new employees
• Collection and reporting of data for QI plan
• Adheres to NASW Code of Ethics
• Maintains compliance with social services standards, hospital policies and procedures and regulatory agency requirements.
• UR-Reviews all acute/swing admission medical records.
• UR-Reports concerns re: admissions and continued stay to Utilization Review Chair person and Medical Director.
• UR- Prepares monthly statistical report for monthly review at the UR Committee meeting.
• UR-Provides clinical reviews to medical insurance companies as requested.
• UR-Collaborates with the Health Information Manager to appeal insurance denials. Set up peer to peer if needed.
• UR- Reports UR statistics to Board Quality quarterly.
• Complete audit on Swing Bed patients for Stroudwater.

• Call all patients s/p hospital stay. Review understanding of discharge instructions and assist with f/u PCP appointments, medications, if needed.

Essential Job Qualifications

• Education:
  • RN, graduate of an accredited school of Nursing or CSW preferred; or B.A. or B.S. in related field -Meets requirements of NYS Department of Health
• Experience:
  • Two (2) years hospital based preferred. One (1) year QA/UR or Case Management preferred. Current knowledge of Federal and State regulations
• Training/License:
  • PRI certification preferred
• Other:
  • Excellent verbal and written communication skills; strong organizational skills

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