Valley View Medical Center
Monitors and manages patient care to promote continuity of care, optimal patient outcomes, patient satisfaction, cost efficiency, and compliance.
Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes. The case manager conducts a comprehensive assessment of the client’s health needs in order to develop a plan of care. The case manager plans with the patient, the primary care physician, other health care providers, the payer, and the community to maximize health care response and quality, cost-effective outcomes.
Consults with nursing staff and multidisciplinary team regularly to evaluate patient's status andappropriateness of medical care, including admission, length of stay, transfer and discharge.
Monitors patient and family satisfaction. Responds to questions and complaints from patients, family members, and payors regarding care.
Participates in discharge planning including coordinating patient transfers to other facilities and coordinating community resources. Provides discharge education and resource referrals to patients.
Performs chart review to identify actual or potential issues with service delivery, patient outcomes and satisfaction, compliance, cost, and reimbursement.
The case manager educates the patient and members of the health care delivery team about case management, the health care and treatment options, community resources, insurance benefits, psychosocial concerns, etc., so that informed decisions can be made.Problem-solves, exploring options to care when available and alternative plans when necessary to achieve desired outcomes. The case manager encourages appropriate use of health care services and strives to improve quality of care and maintain cost-effectiveness on a case-by-case basis.RN Case manager is an advocate for both the patient and the payer to facilitate positive outcomes for the patient, the health care team, and the payer. However, when a conflict arises, the needs of the patient must be the priority.This position is responsible for utilization review activities including insurance requests for clinical information, receiving and communicating authorization numbers and changing the admission status according to medical necessity and physician orders.To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.
JOB FUNCTIONS:Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is a logical assignment to the position. This position description does not restrict the right of management to assign or reassign duties and responsibilities with and without notice.
