Case Manager Full-Time

Description

Join St. Joseph Regional Medical Center in Lewiston, Idaho-where nationally recognized quality meets small-town heart. We're proud to be recognized for excellence and patient safety, including an "A" Hospital Safety Grade from The Leapfrog Group, inclusion in Becker's list of "Great Community Hospitals," and U.S. News & World Report accolades for maternity care.

Here, you'll find a teamwork-first culture, leaders who support you, and coworkers who genuinely have your back. New grads are welcome-we're committed to training, mentoring, and helping you build confidence as you grow. And because we know great care starts with taking care of our people, we offer competitive benefits and a workplace you can feel good about.

If you're looking for a place to do meaningful work, build a career, and feel proud serving your community-you belong at St. Joe's.

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

• Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Assists with 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.
• Knowledgeable 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.
• Collaborates with clinical staff in the execution of the plan of care, and achievement of goals. Discharge Planning
• Under appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning.
• Assists with comprehensive discharge planning. Utilizes critical thinking to execute effective discharge planning. 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.
• Must read, write and speak fluent English.
• 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.
• Must have regular attendance.
• Approximate percent of time required to travel, 0%.
• Performs other related duties as assigned.

Qualifications

Education

• Graduate of an accredited program required: LPN/LVN or RN.
• Master of Social Work with licensure as required by state regulations or Bachelor of Social Work with licensure as required by state regulations.

Licenses/Certifications

• Healthcare professional licensure required as LPN/LVN, Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.

Experience

• One year of experience in healthcare setting.
• Experience in case management, utilization review, or discharge planning a plus.