Care Manager IP

Emory Healthcare•Atlanta, GA

3d•Onsite

About The Position

The Care Manager is responsible for patient care coordination from admission through discharge, ensuring smooth transitions of care as the patient is discharged from the hospital setting. This role ensures and facilitates high-quality clinical and cost outcomes, procures and secures post-acute services, and coordinates and advocates for patients and families with both internal and external stakeholders. The Care Manager identifies and addresses potential barriers to care coordination/discharge planning to foster efficient care delivery and maximize reimbursement. The CM begins the process of care coordination at the time of the patient's admission by completing a thorough admission assessment and/or psychosocial assessment, which allows for a timely and accurate capture of information and facilitates the initiation of a discharge plan. The CM is an integral part of the interdisciplinary care team, required to attend rounds, care conferences, and/or care team meetings. The CM acts as a representative of both the hospital care team and the patient/family to balance patient/family choice and projected care coordination needs with the ability to execute such services. The CM works with the hospital care team and the patient/family to plan and implement the best possible plan for the patient, considering various factors, limitations, and patient/family preferences. The CM identifies and recommends post-acute services and completes referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family and the care team. Through continuous assessment and review, the CM applies critical thinking to ensure alignment and appropriateness of post-acute services as the patient clinically progresses throughout their stay. Ultimately, the CM is responsible for ensuring the discharge plan is aligned to be executed with the patient's medically cleared for discharge date and the projected length of stay as provided by the payor. The CM identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption. The CM escalates cases, as appropriate, to management, Physician Advisor, Complex Care team, and/or Ethics committee. The CM educates patients/families and the care team regarding post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources. The CM provides supportive and therapeutic communication for patients, families, and loved ones experiencing anxiety or stress due to illness, injury, or physical limitations. The CM must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression that reflects favorably upon the organization. The CM initiates and facilitates discussions with payors to advocate on behalf of the patient and hospital to reduce non-covered, non-authorized, or denied services. The CM issues and administers notices of non-coverage and potential liability to patients in accordance with predetermined regulations, policies, and procedures. The CM serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures pertaining to Discharge Planning and Care Coordination. The CM ensures compliance with all regulatory requirements related to Government and Commercial Payors, third-party payers, and federal and state regulatory agencies. The CM ensures proper use of Case Management Systems and workflows and meets productivity expectations and successfully completes yearly competencies.

Requirements

RN CM: Valid, unencumbered Registered Nurse License approved by the Georgia Board of Nursing.
RN CM: Two (2) years' experience in healthcare.
SW CM I: Masters in Social Work from an accredited school of social work.
SW CM I: Demonstrated knowledge of software/EMR applications.
SW CM II: Masters in Social Work from an accredited school of social work.
SW CM II: Licensed as a Master Social Worker (LMSW) through the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage & Family Therapists.
SW CM II: Demonstrated knowledge of software/EMR applications.
SW CM III: Masters in Social Work from an accredited school of social work.
SW CM III: Licensed as a Clinical Social Worker (LCSW) through the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage & Family Therapists.
SW CM III: Demonstrated knowledge of software/EMR applications.

Nice To Haves

RN CM: Bachelor’s degree in Nursing from an accredited school of nursing.
SW CM I: One (1) year healthcare experience in Acute Care setting.
SW CM I: Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification.
SW CM II: Two (2) years' healthcare experience in Acute Care setting.
SW CM II: Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Manager (CCM) through the Commission for Case Manager Certification.
SW CM III: Three (3) years' healthcare experience in Acute Care setting.
SW CM III: Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Manager (CCM) through the Commission for Case Manager Certification.

Responsibilities

Patient care coordination from admission through discharge
Ensuring smooth transitions of care
Facilitating high quality clinical and cost outcomes
Procuring and securing post-acute services
Coordinating and advocating for patients and families with internal and external stakeholders
Identifying and addressing potential barriers to care coordination/discharge planning
Completing thorough admission assessment and/or psychosocial assessment
Attending rounds, care conferences, and/or care team meetings
Acting as a representative of the hospital care team and the patient/family
Identifying and recommending post-acute services
Completing referrals to appropriate post-acute care providers
Applying critical thinking to ensure alignment and appropriateness of post-acute services
Ensuring the discharge plan is aligned for execution with the patient's medically cleared for discharge date and projected length of stay
Identifying and participating in the development of strategies to reduce unnecessary length of stay and/or resource consumption
Escalating cases, as appropriate, to management, Physician Advisor, Complex Care team, and/or Ethics committee
Educating patients/families and the care team regarding post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources
Providing supportive and therapeutic communication for patients, families, and loved ones
Initiating and facilitating discussions with payors
Issuing and administering notices of non-coverage and potential liability to patients
Serving as a resource to the Physician, Interdisciplinary Care Team, and patient for interpretation of external regulations and organizational policies and procedures
Ensuring compliance with all regulatory requirements as it relates to Government and Commercial Payors, third party payers, and federal and state regulatory agencies
Ensuring proper use of Case Management Systems and workflows
Meeting productivity expectations and successfully completing yearly competencies