CASE MANAGEMENT SPECIALIST

The Case Management Specialist (RN) and Social Worker (SW), as part of a Multidisciplinary Care Team and demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

The purpose of the Case Management Specialist position is to work with an assigned patient population to promote the achievement of optimal clinical and resource outcomes. Responsible for managing appropriate lengths of stay for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the multidisciplinary team. Works to develop organization-wide approaches to problem solving, analyzes current systems and variances to identify opportunities for improvement and works to promote quality of care through collaboration with all service team members, patients, and families. Works with the leadership team to align the goals and vision. The Case Management Specialist plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources.

Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery.

Facilitate transfer of patients to the most appropriate level of care and in accordance with CMS Discharge Planning regulations.

Coordination of care for the patient during their hospital stay and effect appropriate and timely transition to sub-acute setting that best meet the patient’s needs.

Coordination of communication with physicians.

Float to other units where support is needed by another Case Managers

Participate in Process Improvement methodologies in evaluating outcomes of care and interventions.

Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient population served.

Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles. Specific age groups that are served by this position are noted below:

· Neonatal/Newborn (birth – 30 days) - PEDS, NICU, OB, ECC

· Infant (30 days – 1 year) - PEDS, NICU, ECC

· Pediatric (1 – 12 years) - PEDS, ECC

· Adolescent (13 – 17 years) - OB, M/S, CC, ECC

· Adult (18 – 64 years) - OB, M/S, CC, ECC

· Geriatric (65+ years) - M/S, CC, ESS

Serves as a patient and family advocate.

Contributes to organizational targets for length of stay reductions overall and for Hospital Medicine.

Builds relationships within the organization serves as a resource to the healthcare team related to discharge planning.

Collaborates and facilities multidisciplinary rounds and care with physicians and all other members of the team including the patient and their family to:

o Ensure continuity, timeliness, and appropriateness of care for designated case load.

o Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

o Ensures timely completion and reporting of diagnostic testing, initiation, and completion of treatment plan and all required documentation.

o Facilitate and coordinate transfers of patients to other facilities

Reviews cases for quality or risk management issues and intervenes when indicated.

Involved in the process of presenting notices of non-coverage

Maintains an understanding of reimbursement methods and monitors cost-effective care, therefore, preventing duplication or fragmentation of care and curtailing operational and clinical delays.

Identifies patients with potential for extended length of stay or variances and collaborates with multidisciplinary team to develop interventions to correct the issues.

Evaluates effectiveness of interventions on outcomes that measure cost and quality such as LOS and variances from expected outcomes.

Interprets patient response and collaboratively identifies interventions to maximize positive outcomes.

Works with the Healthcare team to demonstrate fiscal responsibility by being conscious of the need to appropriately use the resource dollars available and identify and pursue opportunities.

Helps to implement standards of care, standards of practice, hospital policies and critical pathways.

Through case management efforts, assists in meeting all accreditation and licensing processes.

Actively prepares and participates in accrediting agency surveys.

Assists in planning, implementing, and evaluating quality improvement.

Manages conflict effectively, striving for win-win outcomes.

Engage in continuing education to improve knowledge, skills and maintain CEU’s for licensure.

Maintains patient confidentiality according to all applicable laws, policies, and regulations.

EDUCATION/EXPERIENCE

Registered Nurse OR Masters Degree in Social Work
Registered Nurse:
RN with a bachelors degree in healthcare related field or will be working toward completion of bachelors degree within 6 months and completion of program within 3 years, minimum of 3 years acute care experience.
OR
RN with a Minimum of an Associates degree in nursing and a current license in the State of Michigan, 2 years of bedside nursing, 5 years in an acute care setting and 5 years of case management experience
Social Work:
Masters degree in social work from an accredited school of social work required.
Minimum of three years experience in a healthcare facility or related community agency preferred.
AND
Current Licensed Masters Social Work with the State of Michigan or able to obtain an LMSW within 6 months of being eligible.
OR
Current Limited License Masters Social Work clinical license with State of Michigan or able to obtain an LLMSW within 6 months of hire.

KNOWLEDGE/SKILLS/ABILITIES

Demonstrated clinical competence.

Has exceptional understanding of the disease process and treatment regimens associated with designated patient populations.

Maintains current knowledge by attending conferences, seminars and reads journal or research articles.

Demonstrates critical thinking skills, analyzing multiple issues impacting outcomes.

Excellent problem-solving skills and the ability to manage many situations simultaneously.

Able to adjust to priorities that may change minute by minute.

Strong commitment to collaboration and teamwork, with demonstrated ability to work as a member of a team where assignments must be coordinated with peers.

Demonstrates good computer skills. EPIC experience strongly preferred

Demonstrates excellent communication skills, negotiation skills, diplomacy, and assertiveness

Has a solid understanding of the Healthcare industry, technology, and regulations.

A professional approach to work, including a strong sense of responsibility for assigned duties.

Demonstrates excellent customer service and communication skills.

Ability to work independently as well as a part of a multidisciplinary team and exercise sound judgment in interactions with physicians, payors, and patients and their families.

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards.

Frequent standing, walking, sitting, talking, hearing.

Occasional lifting to 100 or more lbs.

Occasional carrying, pushing, climbing, balancing, stooping.

Occasional kneeling, crouching, squatting, crawling, twisting.

Occasional reaching, handling, feeling, near vision.

Occasional midrange vision, far vision, depth perception.

Occasional visual accommodation, color vision, field of vision.