Case Management Liaison (Full Time)

Admin
December 9, 2021 / 5 mins read

Department: Nursing

Position: Case Management Liaison

Job Type: Fulltime, Monday - Friday

Reports to: Chief Nursing Officer

The Case Manager (CM) Liaison is responsible for assessing, planning, facilitating, coordinating, evaluating, and advocating for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

The CM Liaison is responsible and accountable for the Case Management of all patients to facilitate efficient, cost-effective, quality care, including appropriate utilization of resources, proactive discharge planning, continuity of care, multidisciplinary team approach and patient advocacy. The CM Liaison acts as the collaborative agent on the multidisciplinary care team to facilitate the patient’s movement through the continuum of care while ensuring the maximum outcome goals for the patient are achieved. Responsible (shared) for the referral intake process of potential swing bed patients including communication of potential patients to the multidisciplinary team, collaboration with multidisciplinary team to expedite acceptance decision, obtaining precertification of insurance requirements as applicable and verifying patient meets criteria for swing bed admittance. The CM Liaison will serve as a liaison to the patient/family and caregiver teams to ensure coordination of healthcare services are met at transitions of care.

  • Reviews all admissions for medical necessity and reviews all patients daily for necessity of continued stay; tracks and analyzes clinical and financial data to support clinical decision-making.
  • Facilitates and attends meetings between patient, family/caregiver(s), care team, payers, and community resources.
  • Communicates and interacts directly with all members of the multidisciplinary care team, the patient and family/significant others for planning and facilitating the plan of care for each patient
  • Analyzes care needs of the patients, implements care plan with measurable goals and monitors progress toward achieving desired outcome goals; revises care plan as needs change and ensures patient access to appropriate medical and specialty providers.
  • Educates patient and family/caregiver(s) about relevant community resources; interacts with referral sites and community providers for coordinating appropriate patient care needs during each transition of care.
  • Completes timely post-hospital discharge calls and follow-up including medication reconciliation, f/u appointments, review of discharge instructions and assessing for any education needs to prevent readmissions.
  • Reviews the Utilization Review (UR) Plan annually.
  • Attend all training courses/webinars and meetings as required
  • Attends the quarterly UR meetings; review UR reports, participates with Quality Management input.
  • Collaboratively reviews case denials for non-payment and coordinates appeal responses, tracks and trends for UR and performance improvement opportunities.
  • Performs CM/UR department requirements in accordance with all Federal and State guidelines.
  • Completes timely post- hospital discharge calls and follow-up including medication reconciliation, PCP, or specialist follow-up appointment, assessing symptoms, teaching warning signs, reviewing discharge instructions, coordinating care and problem-solving barriers.
  • Collaboratively and actively participates in maintaining swing bed patient census through open communication with referring agencies.
  • Evaluate referred patients’ appropriateness for acceptance into the Swing Bed Program, facilitate acceptance decisions and communicate acceptance to referring facility in a timely manner.
  • Coordinate patient transfers with case management/discharge planners at referring facilities to assure an optimal hand-off and transition in care.
  • Monitor patient clinical documentation and program participation to assure compliance with payer requirements for reimbursement purposes.
  • Facilitate weekly and/or PRN multidisciplinary care team meetings and document continuation or changes in patient’s plan of care.
  • Provide brief orientation of swing bed services to patient and/or family upon admission to the SB program.
  • Maintain open communication with the patient/family and caregiver team regarding discharge planning needs and choices.
  • Identifies each patient needs for medically related social services and discharge needs; pursues the provision of these services.
  • Provide annual review and maintenance of relevant swing bed policies and procedures.
  • Actively participates and assists in maintaining SB Program marketing strategies.
  • Ensure compliance with relevant regulations, standards and directives from regulatory agencies and third-party payers.
  • Completes timely post- hospital discharge calls.
  • Other duties as assigned related to Case Management.

Requirements:

  • Computer Knowledge: Must have strong computer skills; proficient in Microsoft Office (Word, Outlook, and Excel)
  • Working knowledge of criteria for Medicare, Medicaid, and all third-payor sources
  • Working knowledge of InterQual criteria
  • Exhibits critical thinking, problem-solving and analytical skills
  • Demonstrates professional, appropriate, effective, & tactful written, verbal, & nonverbal communication skills
  • Must have a positive and respectful attitude and demonstrate professional customer service skills
  • Self-initiative with ability to lead and facilitate process improvement.

Type: Full-Time Days

Qualifications:

  • Current RN licensure in the State of KY; Bachelor’s Degree in nursing preferred.
  • Minimum of three years’ experience in an acute adult patient care clinical role.
  • 1-2 years Case Management experience in health care environment preferred.
  • CCM preferred.

Language Skills:

  • Ability to read and communicate effectively in English.
  • Additional languages preferred

Submit resume and application to Melissa Vickery, HR Director at mvickery@waynehospital.org or by visiting the WCH website at www.waynehospital.org

Application Period: December 9, 2021 until filled