Patient Care Manager - LLMSW or MSW

Munson Healthcare•Cadillac, MI

About The Position

The Patient Care Manager facilitates progression of care and monitors patient progress to ensure the plan of care and services provided are patient-focused, high quality, evidence-based, appropriate to patient needs, efficient, and cost-effective. The role applies Relationship-Based Care principles and effective customer service and interpersonal skills, and maintains working knowledge of utilization management, managed care, and payer issues that may affect the course of care. The manager responds to case management screening referrals, identifies community resources, and collaborates with patients, families, multidisciplinary teams, and community agencies to support desired outcomes. The role advocates for appropriate levels of care, promotes patient and family participation in treatment decisions, supports medical compliance, and helps identify and address readmission and psychosocial risks. It also coordinates discharge planning and post-acute services, monitors medical necessity and eligibility, and works to resolve progression-of-care barriers and improve clinical and financial outcomes. The Patient Care Manager participates in quality improvement activities and departmental studies, may assist with training and orientation, and performs other duties as assigned. The position is full-time, 40 hours per week, Monday through Friday, 8:00 AM to 4:30 PM, on the day shift.

Requirements

MSW required.
Minimum LLMSW limited license required at time of hire.
Employees must be vaccinated or have lab-confirmed immunity for Measles, Mumps, Rubella, and Varicella.
Employees must receive a flu vaccine during the flu season in the year they are hired and annually thereafter, or receive an approved medical or religious exemption.

Nice To Haves

Recent hospital patient care experience and knowledge of hospital operations preferred.

Responsibilities

Facilitate progression of care and monitor patient progress to ensure appropriate, patient-focused, high-quality, evidence-based, efficient, and cost-effective care.
Apply Relationship-Based Care principles, meet expectations outlined in Commitment To My Co-workers, and support unit action plans.
Use effective customer service and interpersonal skills.
Maintain working knowledge of utilization management, managed care, and payer issues that may affect the course of care.
Respond promptly to screening referrals for case management services.
Identify appropriate community resources and collaborate with patients, families, multidisciplinary teams, and community agencies to achieve patient outcomes.
Confirm admission diagnoses and identify related quality and care metrics to promote medical compliance.
Advocate for patients by assessing whether their healthcare needs are being addressed at the most appropriate level of care.
Encourage and facilitate patient and family participation in care and treatment decisions.
Educate members of the healthcare team on appropriate access to and use of various levels of care.
Identify patients at risk for readmission, refer them for community-based follow-up, and respond appropriately to readmission or psychosocial risk factors.
Consult with a physician advisor as necessary to resolve progression-of-care barriers through administrative and medical channels.
Serve as the primary liaison among physicians, patients, families, payers, external case managers, and the interdisciplinary clinical team.
Participate in discharge planning for complex patients to support timely discharge and appropriate linkage with post-discharge care providers; refer appropriate cases to the Complex Discharge planner.
Collaborate with Post-Acute Coordinators to monitor and facilitate completion of complex post-acute services.
Interface with utilization review specialists regarding patient eligibility for admission, continuing stay, or discharge readiness according to medical necessity guidelines, including InterQual criteria.
Work to influence clinical and financial outcomes of care and identify and record preventable delays or avoidable days caused by progression-of-care process failures.
Participate in quality improvement activities and departmental research or studies as requested by the department manager.
Manage resource utilization while supporting the patient's movement along the continuum of care.
Collaborate with social workers, counselors, and Resource Center coordinators to research discharge placement options when home discharge is not possible, considering patient and family goals, team recommendations, payer benefits, and private financial considerations.
Use the Program Manager, Director, and Medical Advisor as expert advisors on physician and Resource Management issues.
Work with the resource center and providers to determine patient eligibility for post-acute services.
Assist with training and orientation of new department employees and students as needed, and perform other assigned duties.