Job Summary
Provides, coordinates, and facilitates patient discharge planning in collaboration with other health care professionals during hospitalization, ED visits and/or clinic visits. Assist with organizing services across provider lines, between people, and systems to affect optimal patient outcomes, achieve continuity of care and reduce costs.
Responsibilities
• Promote the mission, vision, and values of the organization.
• Identifies patients for teaching, discharge, and extended care facility needs.
• Collaborates with physicians, caregivers, patient, family, other departmental team members, and payor to proactively develop and implement a safe and appropriate discharge plan.
• Participates in team meetings that foster interdepartmental collaboration with the patient and their family as deemed necessary, this includes multidisciplinary meetings and Utilization Review/Case Management meetings. Provides input in such meetings regarding utilization management and discharge planning.
• Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, level of care, and readiness for discharge; refers cases that do not meet criteria to Case Management Director and/or Medical Staff.
• Maintains working knowledge of Medicare, Medicaid and private insurance company coverage for referred products and services.
• Communicate daily with admissions personnel regarding admissions and discharges to various facilities.
• Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system.
• Knowledgeable of patient’s financial status, diagnosis and discharge needs and documents these as an ongoing review.
• Assist as needed with obtaining referrals, prior authorization for Home Health Care, DME, SNF, acute rehab and appointments.
• Maintains a current list of resources for referrals and refers to the appropriate inpatient, outpatient and community resources.
• Participate in and complete discharge assessments, complete follow up phone calls in a timely manner and provide referrals/ data according to the patient’s needs.
• Participate and communicate with the care team in management of the patient through the program.
Experience & Skills Needed:
• Ability to maintain patient confidentiality at all times.
• Knowledge of Utilization management principles, HCFA guidelines, Swing Bed, home health care, skilled nursing facilities/long term care and durable medical equipment is highly desirable.
• Knowledge of nursing services and insurance coverage preferred
• Strong organizational and interpersonal skills
• Ability to determine appropriate course of action in more complex situations
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work
• Ability to maintain confidentiality of all medical, financial, and legal information
• Ability to complete work assignments accurately and in a timely manner
• Ability to communicate effectively, both orally and in writing
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.