Clinical Case Manager
Category: Allied Health/Clinical Professional
Job Requisition: 11601
Department: Utilization - Case Management
Facility: MedStar Georgetown University Hospital
Geographic Region: Washington, DC
Schedule: Full Time
Shift: Day Shift, Monday-Friday, 8:30am-5pm
Hours per Week: 40.00
Location: Washington, DC
General Summary of Position:
Monitors the care and services delivered to selected patient populations during the acute hospital stay, promotes effective utilization of resources and assumes a leadership role with the interdisciplinary team to achieve optimal clinical and resource outcomes for the prehospital, acute, and posthospital phases of care. Develops and maintains a positive work climate and supports the overall team effort of the health system. The functions are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital's philosophy, policies, procedures and standards.
EDUCATION AND/OR TRAINING REQUIRED: Masters Degree in Social Work or Bachelor’s Degree in Nursing required; Advanced Degree preferred.
LICENSURE AND/OR CERTIFICATION: Licensed as a Nurse or Social Worker in the District of Columbia; Specialty certification desirable.
EXPERIENCE: Three years clinical experience in an acute care setting. Utilization management and/or case management experience preferred.
SPECIAL KNOWLEDGE AND SKILLS: Advanced communication and interpersonal skills. Demonstrated ability to manage information for the purpose of setting goals and measuring success. Willingness and ability to explain case management, managed care and reimbursement concepts and requirements to patients, families, and staff. Willingness and ability to coach colleagues and new staff in areas of professional expertise. Ability to determine when a referral to other departments is required by the patients clinical, social, or financial situation. Ability to interact with clinical departments as necessary to clarify components of the treatment or discharge plan. Ability to maintain effective communication with all members of the care team: patient, family, and hospital colleagues. Skill and proficiency in applying highly technical principles, concepts and techniques that are central to the health care professions.
Consideration will be given to an appropriate combination of education/training and experience.
Primary Duties and Responsibilities:
Assesses, facilitates, and monitors the plan of care in conjunction with the patient and/or family/significant other. Communicates the need, or lack of, continued hospitalization and ensures patient understanding of third party payer guidelines.
Conducts concurrent chart review of selected patient populations, assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and completeness of medical record documentation.
Reviews all patient admission data within the designated timeframes to determine the suitability of the level of care in accordance with established guidelines.
Identifies issues/problems and makes appropriate recommendations. Communicates with patients, families/ significant others, medical staff, caregivers, and third party payers, as necessary.
Coordinates care within MGUH and other settings by monitoring and overseeing the continuum of clinical care, ensuring necessary meetings are held with patient/family and the interdisciplinary team to coordinate treatment and discharge plans. Arranges discharge-planning referrals as ordered by patient’s physician.
Serves as a facilitator/advocate for patients and families in the resolution of problems related to the established plan of care and procurement of services.
Monitors the daily activity of on-site reviewers for consistency and correctness in the application of standards for admission and continued stay.
Produces case documentation in approved manual or electronic format while maintaining required departmental standards and protocols.
Participates in the development and standardization of improved pathways and best practice scenarios.
Assumes other duties and responsibilities that are appropriate to the position and area.
The above responsibilities are a general description of the level and nature of the work assigned to this classification and is not to be considered as all-inclusive.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations.
A qualified individual with a disability will be considered for employment on the same basis as non- disabled applicants if he/she can perform the essential functions of the job sought, with or without a reasonable accommodation, and without imposing a direct threat to the health or safety of others or him/herself.
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