What are the responsibilities and job description for the Case Manager position at King's Daughters?
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JOB SUMMARY
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The case manager works collaboratively with an interdisciplinary team both internal and external to the organization to improve patient care management and promote continuity of care through effective utilization and monitoring of healthcare resources and assumes a leadership role to achieve desired clinical and financial outcomes. The case manager provides ongoing support and expertise through comprehensive clinical and psychosocial assessment, planning, implementation and overall evaluation of individual patient care needs. The overall goals of the case manager are achieved through integrating the functions of case management, utilization review, and discharge planning.
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DUTIES AND ESSENTIAL FUNCTIONS
- Coordinate the integration of care management functions into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities to promote effective and efficient utilization of clinical resources. Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post-hospital needs.
- Assesses patient care required throughout continuum of care for diagnosis, procedures and DRG’s. Conduct concurrent medical record review using specific indicators and criteria as approved by medical staff, JCAHO, CMS, and other state agencies.
- Calls all review information to the appropriate reviewing agency for certification of days and initiates denial management processes as necessary.
- Ensure that patient tests are appropriate and necessary and are carried out within the established timeframe and that results are promptly available and acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
- Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assist physicians to maintain appropriate cost, case, and desired patient outcomes.
- Assess patient’s progress through expected hospital course.
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EDUCATION/LICENSE/ CERTIFICATIONS/OTHER REQUIREMENTS
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Minimum requirement:
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Graduate from accredited program for Registered Nurses.
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Current active licensure in the State of Kentucky as a Registered Nurse.
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Preferred qualifications:
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3-5 years of acute care experience
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Bachelor’s Degree in Nursing
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WORKING ENVIRONMENT
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This job operates in a professional office environment routinely using standard office equipment such as computers.
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The noise level in this position is usually moderate.
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PHYSICAL DEMANDS
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Constantly required to maintain a stationary position behind a computer or while in patient rooms and in the nursing unit.
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Frequently required to move about while rounding on departments and patients.
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Constantly required to communicate with people telephonically and in-person requiring talking and hearing.
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Constantly required to operate a computer and telephone.
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Occasionally required to lift and/or move up to 25 pounds.
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Constantly required to lift and/or move up to 10 pounds.
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Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception.
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