BASIC PURPOSE OF THE JOB

To provide clinically and evidenced based patient care coordination. Support the delivery of safe, effective, high quality and efficient patient care. Collaborates with the care coordination team for discharge planning and implementation of home health care and related services to assigned patients. Coordinates prior insurance authorization for services and medications, coordinates the clinical and financial components of case management.

REPORTS TO

• Director - Care Coordination

JOB REQUIREMENTS

Supervisory Responsibilities: No

Minimum Education: Bachelors required; Masters preferred

Degree: Nursing

License/Certification Required: TN or Compact RN Licensure Required; Case Management certification desired

Minimum Work Experience: 1 year as a Case Manager

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES

• Computer literacy including word processing
• Business skills and excellent written and verbal skills
• Working knowledge of payer requirement, contracts and managed care required

DUTIES AND RESPONSIBILITIES

• Reviews clinical and social data for patients referred by social work within 24 hours or first business day. Identifies case management needs through review of record, participation in rounds, care conferences and clinician/family contact.
• Participates in benchmarking efforts via data collection, analysis and formulation of recommendations.
• Advocates to facilitate positive outcomes for the client and the health care team. Provides requested documentation to providers/vendors to support “medical necessity” review/prior-authorization of ordered services and /or equipment, as available.
• Assures thorough, early and ongoing transition/discharge plans by collaborating with patients, families, payers and providers across the continuum of care.
• Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
• Plans with client, family or caregiver, the primary care physician/provider, other health care providers, the payer, to maximize health care responses, quality and cost effective outcomes.
• Actively participates in relevant meetings and committees.
• Collaborates with leaders in program development, supports change and adapts to meet program goals.
• Seeks new knowledge and participates in learning opportunities to support the care of children with medical complexities and their caregivers.
• Willingly accepts any other assignment that may be requested.
• Utilizes hospital resources and time respectfully and accountably.

PHYSICAL REQUIREMENTS

• Note: Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.
• Light lifting, pushing and pulling is required for 1-20 lbs occasionally and frequent moving of objects of less than 10 lbs is required. Frequent sitting with some walking, standing, squatting, bending, and reaching is required. Keyboard/computer use and/or repetitive motions may be required.

Come work where you can make a difference everyday.