High Risk Case Manager - Full-time

Stamford Health•Stamford, CT

10h

About The Position

Stamford Health is seeking a High Risk Case Manager to join our team in Stamford! The High Risk Case Manager is responsible for coordinating the care and instituting appropriate interventions to an assigned group of high risk patients with complex care needs identified through payor programs and internal mechanisms. Assesses plans and evaluates the outcomes of care in collaboration with the other members of the health care team. Guides and collaborates with health care team members within the continuum to ensure quality and cost-effective care is given within a timely manner and an appropriate, safe post-acute plan has been facilitated. Focus on readmissions and interventions to improve transitions of care. Schedule: Monday - Friday 8:00 am - 4:30 pm

Requirements

Bachelors prepared Registered Nurse licensed in the state of Connecticut is required.
Social work license for LMSW is required.
Strong clinical experience in an acute care setting with additional experience in home care, long term care and case management is preferred. Professional certification in case management or clinical specialty is highly desirable. Additional licensures including LPNs and LCSWs will be considered when paired with extensive relevant experience
If not certified, will obtain ACM or CCM certification within one year of hire.
Strong organizational and communication skills are essential.
Completes required department and organization training and education in a timely manner.
Demonstrates professional work behavior by following Stamford Health Standards for Service Excellence
Complies with departmental organizational policies and procedures and adheres to external agency requirements.
Strong leadership, interpersonal, strong problem solving, goal setting, and decision-making skills. Prior case management, utilization management or discharge planning experience preferred. Experience with multi-aged and multicultural populations. Ability to work autonomously and managed time effectively and to work within a multidisciplinary team structure and large physician base.
Knowledge of legal and regulatory issues and insurance and third-party reimbursement. Experience with medical cost containment, resource utilization. Strong computer skills.

Responsibilities

Works in conjunction with assigned social worker/case manager coordinating complex patient care throughout the continuum of care among the interdisciplinary team for identified population with a focus on complex LOS issues, readmission.
Works in conjunction with clinical teams and case management inside and outside of Stamford Health to coordinate complex patient care throughout the continuum of care. Works with the interdisciplinary team for identified populations with a focus on high risk, high cost and high utilizer patients
Independently develops High Risk program initiatives
Works with Quality Department team to follow readmission data and trends based on data in the EMR and data shared by insurance payors to identify areas for improvement and patients for management.
Prepares reports in PowerPoint format and presents at appropriate meetings
Assists in facilitating theParticipates in the system Transitional Care Committee meetings (TCC)
Provides ongoing assessment and case management of identified patient population to ensure an accurate evaluation of patient needs, appropriate level of care, proper resource utilization, and quality of care and risk management in post-acute setting. Develops goals for patient outcomes based on assessment within identified time and documents in clinical records as indicated with the assigned Case Manager and Social Worker. .
Monitors and evaluate the plan of care on an ongoing basis and revises goals as needed.
In coordination with social work/case management maintains ongoing communication regarding patient care with physicians, referral sources, caregivers, patients, etc. to facilitate, coordinate, and transition
Independently initiates assessments of situations, identifies, and explores alternatives and chooses appropriate course of action in areas within scope of practice.
Acts as an advocate for individual’s health care needs. Identifies barriers and advocates for patient to access to care. Identifies system problems within the acute & ambulatory care system as well as the community which are barriers to timely care.
Incorporates Social Determinants of Health issues into the plan of care
Responsible for maintaining a professional relationship with referral sources and community resources and participating in local professional organizations and activities.
May conduct visits in the field, home, skilled nursing facility, doctor’s office, etc. when needed to assess and/or evaluate patient’s needs or environment of care.
Provides patients and families support and information about their current condition, diagnosis, and co-morbidities.
Provides education and support to hospital health system staff regarding community resources, managed care issues, or payment/ payer issues.
Demonstrates an ability to be flexible, organized, and functional under stressful situations. Utilizes critical thinking skills and sound judgment in priority setting and delegation.
Practices autonomously, consistent with evidenced-based standards. Pursues personal and professional growth and development.