Senior Case Manager - Hospital Care Coordination

ScionHealth; Los Angeles (CA); Hybride; USD 69 000 - 87 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

401(k)

FSA/HSA

Life Insurance

Paid Time Off

Wellness program

Résumé du poste

ScionHealth's Kindred Hospital Los Angeles seeks a Care Coordination professional to oversee patient flow and ensure seamless transitions across the continuum of care. You will collaborate with the ICT team, physicians, and families to optimize resource use, advocate for patients, and support discharge planning.

You will monitor care delivery, perform timely utilization reviews, and coordinate with post-acute providers and payors to maintain quality and cost effectiveness.

Qualifications

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes.
• Knowledge of accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, prioritization and time management.
• Basic computer skills with Microsoft Office applications.
• Excellent interpersonal, verbal and written communication skills.
• Must read, write and speak fluent English.

Responsabilités

• Coordinate clinical and psycho-social activities with Interdisciplinary Team and Physicians.
• Monitor patient stays for effective care coordination and efficient care facilitation.
• Refer high-risk patients who would benefit from additional support.
• Serve as a patient advocate and maximize informed decisions.
• Participate in rounds to review goals, optimize resource utilization and discharge planning.
• Coordinate with post-acute providers, payors, families in planning care across the continuum.
• Ensure timely and comprehensive discharge planning.
• Promote efficient utilization of clinical resources.
• Adhere to Code of Business Conduct and company procedures.

Connaissances

Interdisciplinary teamwork

Care coordination

Discharge planning

Utilization management

Critical thinking

Communication

Formation

RN

BSN preferred

MSW/BSW licensure (state regulations)

Description du poste

Description

Kindred Hospital Los Angeles helps patients return to the lives they love.

At our hospital, our physician-led care teams provide critically ill patients with the specialized acute care and rehabilitation they need, for the time they need it - empowering them to take the next step in their recovery journey.

Located in Ladera Heights near Fox Hills Park, Blanco Park and Ladera Park, we are a short drive from restaurants and shops, as well as close to public transit.

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

Care Coordination

• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients’ care throughout the care continuum.

Discharge Planning

• Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
• Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning.
• Coordinate and communicates with patient/family efficient and effectively.

Utilization Management

• Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.

Other

• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
• Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Approximate percent of time required to travel, 0%
• Must read, write and speak fluent English.
• Must have good and regular attendance.
• Performs other related duties as assigned.

Pay Range: $49.83-$63.20/hr.

ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.

Qualifications

Education

• Graduate of an accredited program required for RN.
• BSN preferred or MSW/BSW with licensure as required by state regulations

Licenses/Certifications

• Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
• Certification in Case Management a plus.

Experience

• Two years of experience in a healthcare setting preferred.
• Prefer prior experience in case management, utilization review, or discharge planning.