Case Manager - Pond 4- per diem - Yale New Haven Health

Overview:To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Case Manager Is Responsible For Facilitating The Patient's Hospitalization From Preadmission Through Discharge. The Case Manager Coordinates With Physicians, Nurses, Social Workers, And Other Health Team Members To Expedite Medically Appropriate, Cost-Effective Care. The Case Manager Applies Clinical Expertise And Medical Appropriateness Criteria To Resource Utilization And Discharge Planning.

EEO/AA/Disability/VeteranResponsibilities:

• 1. Initiates Discharge Planning By Screening The Patient For Continuing Care Needs.; Assesses Patients With Identified Needs; Develops And Implements A Discharge Plan To Address Patient?S Continuing Care Needs In Collaboration With The Health Care Team, Approval Of The Attending Physician, And Acceptance By The Patient/Family; Monitors Effectiveness Of The Discharge Plan.
• 2. Using Established Criteria, Reviews The Following:
• 3. Appropriateness Of Patient?S Admission.
• 4. Need For Continued Stay.
• 5. Information Needed For Discharge.
• 6. Completes Saga Applications On All Uninsured Patients.
• 7. Collects Data On Variances From Quality Screening Criteria And Forwards This Data To The Cluster Director.
• 8. Monitors The Process Of Acute Care For Any Unexpected (Variant) Response To The Clinical Setting. Makes Timely And Appropriate Referrals That Will Coordinate Intervention To Correct The Variant Response.
• 9. Responds To Third-Party Requests For Concurrent Clinical Information.
• 10. Communicates To Risk Management All Incidents That Are Potentially Compensable Events.
• 11. Issues Letter Of Denial And Reinstatement Within Regulatory Timeframe.
• 12. Coordinates Activities To Ensure Patient?S Appeal Right Under The Discharge Appeals Program. Initiates Appeal Process For Insurance Denials As Appropriate.
• 13. Discusses Estimated Length Of Stay, Treatment, And Discharge Plan With The Attending Physician, And Treatment Team, As Indicated.
• 14. On Daily Basis, Reviews The Patient?S Plan Of Care, And Focuses On The Need For Continued Hospitalization.
• 15. Coordinates And Leads The Staff As Indicated To Ensure The Following:
• 16. Completion And Reporting Of Diagnostic Testing.
• 17. Completion Of Treatment Appropriate For The Acute Episode Of Illness.
• 18. Modifications Of The Plan To Meet The Continuing Care Needs Of The Patient.
• 19. Communication Of Relevant Issues And Third-Party Payer Information To The Team.
• 20. Assignment Of The Appropriate Level Of Care.
• 21. Consults With Physicians, Nursing Staff And Staff In Ancillary Departments And Coordinates The Elimination Of Barriers To Efficient Delivery Of Care In The Appropriate Setting.
• 22. Ensures Timely Completion Of All Discharge, Transfer, And Referral Forms.
• 23. Maintains Clinical Competency And Current Knowledge Of Regulatory And Payer Requirements To Perform Job Responsibilities.
• 24. Maintains Current And Working Knowledge Of Case Management, Utilization Management, Discharge Planning, As Specified By Federal, State, Private Insurance Guidelines.
• 25. Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review.
• 26. Performs Other Duties As Assigned Or Directed To Ensure Smooth Operation Of The Department/Unit.

Qualifications:

EDUCATION

Registered Nurse With Current Ct License. Bachelors Degree In Health Care Related Field Required. Masters Degree Preferred Or Equivalent Experience.

EXPERIENCE

Facilitation Of Health Services Across Level Of Care; Negotiation For Benefits With The Managed Care Environment; Monitoring Appropriateness Of Healthcare Setting; Auditing And Analysis Of Health Care Delivery Practices.

LICENSURE

Registered Nurse With Current Ct License. BLS Required.

SPECIAL SKILLS

Certification Or Eligible For Certification In Case Management A Benefit. Strong Leadership, Communication, And Computer Skills Desired.