Address
Form of workJOB PURPOSE:
Coordinates and monitors all Care Management team activities, provides leadership, coaching, and mentoring to Care Management staff members. Responsible for providing leadership and direction for Discharge Planning and Transitions of Care, within the acute hospital. Monitors for quality indicators to assure appropriate social and transitional services are provided to patients and families. Develops and maintains relationships with physicians, nursing supervisors, payers, community resources/ agencies to provide the needs services for indigent, uninsured, and underinsured populations.
MINIMUM EDUCATION REQUIRED:
Associate's Degree from accredited school of Nursing or Masters in Social Work and current Social Work licensure in the State of Georgia.
MINIMUM EXPERIENCE REQUIRED:
Five (5) years of experience in care management, medical social work or transitional care management.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Registered Nurse (RN) or Licensed Master Social Worker (LMSW) and current license in state of GA
ADDITIONAL QUALIFICATIONS:
Bachelor's degree from accredited school of Nursing preferred.
KEY RESPONSIBILITIES:
1. Provides onsite mentoring, orientation and supervision for Care Management staff to ensure alignment with department metrics.
2. Communicates with charge nurses, physicians, ED staff and leadership regarding complex discharge planning, transitional care, complex psycho/social, psychiatric cases, or high-risk patients that are at risk for readmissions.
3. Provides mediation between the patient, provider, guardians, family members or agencies relative to the needs and desires identified by the patient.
4. Orient new weekend staff and assist in identifying process improvement opportunities
5. Coordinate various aspects of Care Management services; including referral, intake, eligibility determination, program planning, monitoring, assessment, and evaluation of needs and services.
6. Collaborate with post-acute care providers to secure safe and timely discharges.
7. Prepare weekend schedule, monitor PRN staff to ensure compliance w/meeting work requirements.
8. Provide guidance and leadership on complex/acute inpatient and ED patients; assist with educating ED Staff and collaborate with UR on out of network patients and appropriate diversions.
9. Track weekend discharges; discharge delays; escalations, family meetings, etc.
10. Huddle with Charge RNs and MDs to address discharge needs.
11. Huddle with House Supervisor on the weekend to discuss bed needs.
12. Monitor/Audit regulatory compliance of IMM/Moon notices on the weekend.
13. Facilitate weekend huddle to address discharge barriers, Kepro/Medicare appeals and any other escalations.
KNOWLEDGE, SKILLS, ABILITIES
Skill and ability to communicate effectively both verbally and in-writing with Physicians, Nurses and Hospital Departments.
Knowledgeable in care management principles, procedures and practices.
Knowledgeable in crisis intervention principles and practices.
Detailed knowledge of Federal and State Hospital Discharge Planning, Patient Care, Conditions of Participation, DNV, and InterQual / MCG Criteria.
Skills and ability to handle multiple priorities and deadlines.
Ability to work as a member of a team.
Disclaimer
The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified.
