Under general supervision, works independently and as a member of the Case Management team to optimize patients’ progress through the continuum of care. Working in a collegial manner, helps case management develop thoughtful, effective, individualized discharge plans.

• Supports Case Managers in advocating on behalf of patients and in working with hospital administrators and physicians to determine the best course of action for patients’ care.

• Facilitates consistent communication with patients and their caregivers regarding resources available to patients.

• Responds promptly to phone inquiries.

• Helps investigate patients’ insurance coverage and benefits.

• Identifies gaps or barriers in treatment plans, working closely with the Case Management. Manager and/or Director on non routine, difficult or complex cases

• Considering patients’ and caregivers’ specific needs and input, helps coordinate needed post-discharge services and referrals to outside sources.

• With clear direction from the Case Management manager, provides educational materials/resources to patients and their caregivers on disease management.

• Works to ensure that patients, families, case management and nursing staff are notified of final discharge times and transportation arrangements.

• Complies with established hospital, division and department policies, procedures and standards which include, but are not limited to, safety, infection control, use of information systems and confidentiality guidelines.

• Accurately and timely adheres to the automated protocols for “next level of care” referrals. Ensures patients receive and sign, as necessary, all regulatory letters in a timely manner. Documents patient information in an accurate, timely fashion; ensures patient charts are complete, current, and correct.

• Demonstrates strong verbal, writing and organizational skills.

• Responsible for Case Management clerical duties including, but not limited to, photocopying, faxing, mailing, filing, and charting.

• Adheres to department budget guidelines and expense reporting requirements.

• Participates in arranging discharges and pre-scheduling discharges and transportation in timely manner.

• Demonstrates strong interpersonal skills to effectively work with all staff, patients and their families, external contacts, and other business partners at all socio-economic and organizational levels.

• Promotes and strives to maintain a professional, team-oriented, service-conscious environment. Consistently demonstrates strong ethics and sound judgment; maintains the privacy and confidentiality of patient information.

• Serves as a patient advocate.

• Anticipates the needs of providers, staff, patient, and family.

• Demonstrates solid grasp of applicable subject areas and ability to learn relevant terminology, policies, processes, regulations, and applicable laws within assigned subject area.

• Stays abreast of changes and opportunities within the healthcare industry by monitoring referral sites, participating in webinars, workshops/seminars and taking advantage of other informative resources.

• Flexible, open-minded, and adaptable to change.

• Represents Holy Cross Hospital in a professional manner at all community events and when interfacing with all external business partners.

• Stays abreast of state, county, and local resources to help case managers effectively utilize them in developing patient care plans.

• This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.

Qualifications:

• Minimum 1-2 years of experience in hospital setting, acute care, or insurance case management.

• Demonstrable understanding of managed care, UR, risk management and/or discharge planning.

• Demonstrable experience in quality assurance, utilization review, or care management preferred.

• Demonstrable knowledge of medical terminology.

• Basic proficiency using Microsoft Office applications and troubleshooting computer problems