USC CERPP (Center for Enrollment Research, Policy and Practice)
Case Manager - Care Coordination - Full Time 8 Hours Day (7:30AM to 4:00PM) (Uni
USC CERPP (Center for Enrollment Research, Policy and Practice), Arcadia, California, United States, 91006
Case Manager - Care Coordination - Full Time 8 Hours Day (7:30AM to 4:00PM) (Union, Non-Exempt)
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Case Manager - Care Coordination - Full Time 8 Hours Day (7:30AM to 4:00PM) (Union, Non-Exempt)
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USC CERPP (Center for Enrollment Research, Policy and Practice) Job Summary
The purpose of the Case Coordinator position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. Responsibilities
Actively participates in clinical performance improvement activities. Applies approved InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards. Assist in the compilation of physician profile data regarding LOS, resource utilization, denied days, cost, case mix index, patient satisfaction, and quality indicators. Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals. Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective. Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director. Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Completes utilization management for assigned patients. Coordinates/facilitates patient care progression throughout the continuum. Documents relevant discharge planning information in the Affinity GUI System according to department standards. Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the health care team and are documented as necessary to ensure continuity of care. Identifies at-risk populations using approved screening tool and follows established reporting procedures. Initiates and facilitates referrals to the Home Health Liaison for home health care, hospice, and medical equipment and supplies. Manages all aspects of discharge planning for assigned patients. Meets directly with patient/family to assess needs and develop an individualized plan in collaboration with the physician. Monitors all transfer DRG’s. Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Perform 100% UR Review on all Medicare One-Day admissions. Refers appropriate cases for social work intervention based on department criteria. Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Uses data to drive decisions and plan/implement performance improvement strategies related for assigned patients, including fiscal, clinical, and patient satisfaction data. Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues. Requirements
Minimum (Required) : Associates degree in Nursing, current RN licensure in the State of California, and BLS certification. Preferred (Not Required) : Bachelors Degree in Nursing, 3 years of Clinical experience in Utilization Review and Discharge planning in an acute hospital, and Professional certification as a case manager.
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Join to apply for the
Case Manager - Care Coordination - Full Time 8 Hours Day (7:30AM to 4:00PM) (Union, Non-Exempt)
role at
USC CERPP (Center for Enrollment Research, Policy and Practice) Job Summary
The purpose of the Case Coordinator position is to support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. Responsibilities
Actively participates in clinical performance improvement activities. Applies approved InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards. Assist in the compilation of physician profile data regarding LOS, resource utilization, denied days, cost, case mix index, patient satisfaction, and quality indicators. Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals. Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective. Collects delay in service data and data for specific performance and/or outcome indicators as determined by the director. Communicates with Financial Counselor to facilitate covered day reimbursement certification for assigned patients. Completes utilization management for assigned patients. Coordinates/facilitates patient care progression throughout the continuum. Documents relevant discharge planning information in the Affinity GUI System according to department standards. Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the health care team and are documented as necessary to ensure continuity of care. Identifies at-risk populations using approved screening tool and follows established reporting procedures. Initiates and facilitates referrals to the Home Health Liaison for home health care, hospice, and medical equipment and supplies. Manages all aspects of discharge planning for assigned patients. Meets directly with patient/family to assess needs and develop an individualized plan in collaboration with the physician. Monitors all transfer DRG’s. Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Perform 100% UR Review on all Medicare One-Day admissions. Refers appropriate cases for social work intervention based on department criteria. Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Uses data to drive decisions and plan/implement performance improvement strategies related for assigned patients, including fiscal, clinical, and patient satisfaction data. Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues. Requirements
Minimum (Required) : Associates degree in Nursing, current RN licensure in the State of California, and BLS certification. Preferred (Not Required) : Bachelors Degree in Nursing, 3 years of Clinical experience in Utilization Review and Discharge planning in an acute hospital, and Professional certification as a case manager.
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