The Manager of the Care Management department assists with planning, organizing, implementing, and evaluating case management services for Adena Health.
The Manager provides clinical expertise and support to caregivers, serves as a resource for complex discharge planning, and mentors caregivers.
The Manager acts as a resource to caregivers in the use of evidence-based criteria and has a working knowledge of utilization review.
The Manager maintains an awareness of state and national health care trends and regulationsincluding regulatory agencies and the Centers for Medicare/Medicaid Services and monitors Case Management practice to ensure compliance.
The Manager is responsible for fulfilling clinical case management job functions to support the team when needed in addition to the administrative activities of the position.
Job Duties:
Promote Adena's mission, vision, values, and guiding principle
Facilitate care meetings that foster interdepartmental collaboration with the patient and their family as deemed necessary, this includes multidisciplinary meetings.
Provides input in such meetings regarding discharge planning.
Communicate daily with the multidisciplinary team to ensure appropriate, effective, and timely discharge planning for bedded patients.
Monitor caregivers activity to ensure ongoing communication with the patient, patient's caregivers, multidisciplinary team, and post-acute care team to ensure discharge planning begins as soon as possible and all discharge needs are met.
Facilitate communication with physicians to ascertain their plans for a timely discharge, and enhance collaboration with post-acute care service providers.
Assist as needed with obtaining referrals, prior authorization for Home Health Care, DME, SNF, acute rehab and appointments.
Manages the utilization of services, hospital length of stay, and readmission rates.
Facilitates successful discharge planning across the continuum by involving the patient, caregiver(s), physician and/or advanced practice provider and other healthcare team members for assigned patient populations.
Works with patients and families to promote self-management support of chronic diseases through individualized plans.
Ensures adherence to Adena's Utilization Review Plan.
Oversees activities in the Care Management department by ensuring the department is adequately staffed to provide services; observing and evaluating services provided; advocating for needed services; obtaining additional resources as needed; intervening in complex cases and providing caregiver support.
Contributes to the department by performing auditing and monitoring activities, developing/evaluating reports, collaborating with caregivers/leaders throughout the health system, partnering with post-acute care providers, and attending meetings.
Aligns all activities with the goal of the department to ensure CMS guidelines are followed and Conditions of Participation are met.
Education:
Bachelor's Degree Nursing
Certifications:
RN - Registered Nurse with Current Ohio License
Experience:
Three (3) years acute hospital Case Management experience
Management experience preferred
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