Actively supports Care Management plans and processes to measure, assess and improve quality, resource management, patient outcomes and Care Management metrics.
- Reports to Care Management leadership, the identification of avoidable days and other Care Management measures including, but not limited, readmissions, saved days, core measure monitoring, interventions, and delays, to ensure data is accurately collected.
- Implements strategies in collaboration with the health-care team to reduce length of stay (LOS) and resource utilization, never compromising quality or outcomes.
- Ensures patients are in the appropriate LOC according to evidenced based, physician approved criteria and standards and prescribed plan of care
- Ensures authorizations for post acute services are obtained in a timely manner
- Facilitates denial management of post acute services
Facilitates the discharge planning process to ensure patient throughput by (add) collaborating with the health-care team.
- Prioritizes patient’s need for Care Management services based on: target/high volume Diagnosis-Related Group (DRG), high cost, outlier, LOS, frequent inpatient admissions, unplanned readmission or significant variance.
- Identifies risk factors for potential crisis intervention needs related to clinical diagnosis, prognosis and/or patient/family dynamics.
- Identifies and reports ethical situations to manager/supervisor and Ethics Committee for resolution.
- Ensures the multidisciplinary discharge plan is consistent with the patient’s clinical course, continuing care needs and covered services. Evaluates on an ongoing basis the patient’s status and progress toward reaching goals set forth in the plan of care.
- Supports the patient/family decision regarding advance directives or verifying a surrogate decision maker.
- Works collaboratively to assess for clinical, spiritual, financial, educational, functional and psychosocial baselines for patient/family to determine appropriate and realistic outcomes.
- Educates patient/family/support system on the plan of care and expected outcomes. Improves patient/family understanding of and adjustment to the medical diagnosis/prognosis or other care issues.
Emergency Department (ED) Care Management
- Identifies target patient populations most likely to have discharge needs such as but not limited to Primary Care Physician (PCP) Identifies Level of Care (LOC) needs and facilitate discharge planning elderly, chronically ill, underserved, limited or ineffective support system, polypharmacy issues, no Primary Care Physician (PCP) Identifies Level of Care (LOC) needs and facilitate discharge planning of appropriate patients treated ED; thereby reducing ED re-visits or subsequent admissions.
- Identifies the appropriate LOC (Inpatient, Outpatient Observation Stay) and collaborates with the attending Physician as indicated.
- Identifies and provides community resources to ensure a safe transition of care.
Communicates effectively and provides education.
- Collaborates with patients, families and other members of the health-care team to facilitate care coordination.
- Handles complaints/concerns in a prompt and courteous manner; assesses and directs to appropriate person to deal with concerns as needed.
- Care Manager provides patient and family education as it relates to discharge plan.
Portrays a positive professional public image at all times.
- Consistently works toward standards of excellence to continually improve personal performance.
- Develops professional relationships with community partners.
- Builds and maintains positive, professional relationships with the health-care team, placing organizational/team goals first.
- Assumes responsibility, authority and accountability for assigned work, seeks to assist team members and identifies opportunities for process improvements.
- Documents data accurately in the electronic medical record and applicable programs to ensure data for tracking and trending is accurate.
- Maintains technical knowledge and skills of computer and integrated software systems.
- Maintains current knowledge of on-line verification/ pre-certification process with insurance carriers.
If applicable to care management facility:
Swing Bed Program
- Maintains established policies and procedures and updates them annually or as needed.
- Responsible for evaluation of patient appropriateness for placement prior to admission to Swing Bed status and appropriateness for continued rehab stay.
- Provide in-services as needed to the Medical/Surgical staff on subjects relating to care of Swing Bed/LTC patients.
- Responsible for provision of Social Activities for Swing Bed Patients.
- Works with patients and families concerning optimal care of patient on the continuum.
Provides Swing Bed patients with the Medicare Notice of Non-Coverage at least 2 days prior to discharge.
Because you’re committed to excellence, you understand the importance of being properly prepared for your role at Mercy. That’s why you’ll bring to your role the right set of qualifications:
- Graduate of an accredited School of Nursing, Required
- Bachelor's Degree of Science in Nursing, Required
- Current License in the state of employment, Required
- 2-3 years acute care hospital setting, Required
- Care Management or Utilization Management experience, Preferred
- BLS (CPR) at hire date, Minimum Required, or within 90 days of hire
- Certification in Case Management, Preferred
Other Skills & Knowledge
- Strong verbal and written communication and facilitation skills, Minimum Required
- Strong assessment skills, time management skills, critical thinking skills, Minimum Required
- Advanced computer skills, Minimum Required
- Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
- Knowledge of InterQual criteria, Preferred
We’ll Support You at Work and Home
Our foundations are built on dignity and respect. Modern Health-care Magazine named us as a “top 100 places to work.” We go out of our way to help people feel welcomed. We offer day-one comprehensive health, vision and dental coverage, PTO, and employer-matched retirement funds, even to part-time employees. We’re proud to provide tuition reimbursement to help you grow and learn new skills.
What Makes a Good Match for Mercy
Compassion and professionalism go hand-in-hand with us, along with exceptional quality care. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and are not afraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a fit for you as well, we encourage you to apply.