Case Manager

Conifer Health Solutions•Joshua Tree, CA

22d•Onsite

About The Position

The individual in this position is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility to assess the patient for transition needs including identifying and assessing patients at risk for readmission. Conducts complex psycho-social assessment and interventions to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention, Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction, and Care Coordination by demonstrating efficient throughput while assuring care is sequenced and provided at the appropriate level of care. This role also involves compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy, and providing educational programs for the Case Management Department on community resource use in discharge planning. The individual will provide reports to the Director of Case Management and hospital leadership as requested, and will be involved in the management of the department, including hiring/training/managing staff, schedule coordination, analysis and reporting, and interfacing/collaborating with other departments.

Requirements

Master in Social Work (MSW)
Demonstrated organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people in a fast-paced environment
Critical thinking and problem-solving skills
Computer literacy

Nice To Haves

Accredited Case Manager (ACM) preferred
Minimum of two years acute hospital experience preferred

Responsibilities

Facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources.
Assess the patient for transition needs, including identifying and assessing patients at risk for readmission.
Conduct complex psycho-social assessments and interventions to promote timely throughput, safe discharge, and prevent avoidable readmissions.
Support medical necessity and denial prevention through Utilization Management.
Promote appropriate length of stay, readmission prevention, and patient satisfaction through Transition Management.
Demonstrate efficient throughput while assuring care is sequenced and provided at the appropriate level of care through Care Coordination.
Ensure compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy.
Provide educational programs for the Case Management Department on community resource use in discharge planning.
Provide reports to the Director of Case Management and hospital leadership as requested.
Manage the department, including hiring/training/managing staff, schedule coordination, analysis and reporting, and interfacing/collaborating with other departments.
Perform complex psycho-social transition planning assessment and reassessment and intervention.
Assist with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and/or federal agencies.
Provide care coordination.
Implement or oversee the implementation of the transition plan.
Lead and/or facilitate multi-disciplinary patient care conferences including Complex Case Review.
Make appropriate referrals to other departments.
Communicate with patients and families about the plan of care.
Collaborate with physicians, office staff, and ancillary departments.
Assure patient education is completed to support post-acute needs.
Provide timely, complete, and concise documentation in the Tenet Case Management documentation system.
Maintain accurate patient demographic and insurance information.
Perform other duties as assigned.