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Case Management Outcomes Coordinator

Location: Mount Gretna, PA
Company: WellSpan Health
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Job Description:
Under the general supervision of the Case Management Supervisor, performs a variety of duties and oversees the progression of care and outcomes for assigned patients. Utilizes case management experience to address care coordination for assigned patients based on STEEEP principles. Coaches and mentors physicians and bedside staff in day to day care coordination and work flows in pursuit of the best patient outcomes. Works in a team model of care involving the patient, hospitalist team, Case Manager, Social Worker and bedside staff to address timely and efficient patient discharge. Oversees data collection and outcomes for assigned patients and works with leadership to identify trends, pursue care improvements and celebrate accomplishments. Provides leadership in the integration of utilization and case management principles throughout the Hospital. Demonstrates tenacity for follow through with tasks, self-directed in day to day work and displays leadership and team work in one's accomplishments.
Duties and Responsibilities
- Engages assigned patients in the active management of their health by encouraging participation in their care and collaborating with the providers on the plan of care, arranging family meetings and successfully completing motivational interviewing training.
- Understands the principles of medical necessity and proactively works with CM staff to execute the discharge plan and procurement of services/ equipment and coordinates with providers of assigned case load.
- Coaches and mentors clinical staff in care coordination, situational awareness, and patient experience caring behaviors, patient engagement.
- Oversees care progression including assessing discharge readiness of assigned patients; leads SIBR rounds, identifying DRG LOS targets using DRG software and clinical judgement to predict discharge readiness, readmission risk, proactively managing barriers and trends in care inefficiencies/ delays to prevent over and/or underutilization using the Avoidable day tracking tool.
- Coordinates all necessary paperwork and referrals for assigned patients including: return to work letters, medical necessity forms, Utilization review notices- IMM and observation, and initiates problem-solving for delays/barriers.
- Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
- Identify conditions which require case management across the continuum. Collaborates with the members of the patient care team including Care Coordination Teams, to identify interdisciplinary needs and effective TOCO status communication with staff.
- Monitors, communicates and assists discharge needs when identified (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
- Assists with the collection and analysis of utilization patterns including avoidable days and denied cases; shares this with assigned clinical leadership.
- Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).
- Concordantly tracks identified quality metrics and takes action to address these measures with the team as needed. Review Readmission, log safety concerns and customer issues when appropriate, and increase team awareness of these events.
- Minimum Experience:
- 2 - 3 years recent Case Management or nursing leadership
- Minimum Education:
- Bachelor's Degree in Nursing
- Preferred Field Of Expertise:
- Utilization management, case management, or clinical nursing specialty
- Required Certification:
- Registration and current RN license in PA
- Skills- Excellent interpersonal/communication skills
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
WellSpan Health and all affiliated entities comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, or any other class protected by federal, state, or local law. WellSpan Health and all affiliated entities do not exclude people or treat them differently because of race, color, national origin, age, disability, sex, or any other class protected by federal, state, or local law.
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