It takes a lot of very smart, hard-working and talented people to provide the level of care that we give to our patients. Tufts Medical Center is an internationally respected academic medical center and we pride ourselves not only on the sophistication of the care we deliver, but the compassionate way in which we provide it. And that starts with our employees.
This position is responsible and accountable for the management of care for an assigned patient population by unit, across the continuum of care. The Case Manager works to achieve daily clinical, quality and cost outcomes by providing well-coordinated experiences for patients/families through the synchronization of care activities of multiple disciplines and negotiating with third party payors.
This is accomplished by negotiating, procuring and coordinating services and resources needed by patient/family; ensuring and facilitating the achievement of quality and clinical customer service; cost and clinical outcomes; intervening at key points for individual patients; addressing and resolving patterns or issues that have a negative quality-cost impact; and creating opportunities and systems to enhance outcomes.
PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:
CARE COORDINATION COMPLETES:
- Case Managers complete assessments on all new admissions to determine the need for all appropriate Case Management services.
- Conducts daily multidisciplinary rounds on assigned units, reviews patient’s plan of care and coordinates:
- Assessment of patient/family needs
- Completion and report of diagnostic tools in a timely manner
- Completion of treatment appropriate for the acute episode of illness
- Modification of plan to meet continuing care needs of the patient
- Monitors ongoing process of gathering adequate information from all relevant sources to insure operation of plan
- Discusses estimated length of stay, treatment and discharge plan with the attending physician and healthcare team
- Establish strong, collaborative relationships with your physicians and team members
- Discusses with MD the appropriateness of resource utilization, consults and treatment plan
- Ensures that the interdisciplinary care plan and discharge plan are consistent with the patient’s clinical course, covered services and continuing care needs.
- Identifies patients and families with complex psychosocial, financial and legal discharge planning needs and refers them to social work.
- Incorporates knowledge of clinical expertise, quality initiatives, insurance and finance into decision-making and problem solving of individual patient cases and across case type during care management activities.
- Fosters and maintains a positive working relationship with referral agencies and liaisons to enhance patient flow.
- Collects and reports on quality projects, i.e.:
- Re-admissions within 30 days
- Delay Day Variances
- Risk management
- Quality improvement
- Documents patient/family progress towards discharge and all critical events and information associated with the hospital stay in SoftMed.
- Supports the EMR and all computer programs, including SoftMed and Soarian.
- Using Interqual criteria, reviews appropriateness of admission, the need for continued stay and information needed for discharge.
- Responds to third party payor requests for concurrent clinical information in timely manner.
- Ensures that documentation in the medical record supports the admission and continued stay, in order to reduce denial rate.
- Documents care management activities in the initial assessment and as the patient progresses towards discharge and at discharge.
- Inteacts with Admitting, Financial Counselors, Insurance Case Managers, Finance and Screeners as appropriate.
- Maintains clinical competency and current knowledge of regulatory and payor requirements to perform job responsibilities.
- Works with documentation specialist to have accurate length of stay information.
- Provides superior customer services to all internal and external clients, customers and patients
- Completes roles and functions related to discharge planning/coordination including case identification, high risk screening, assessment of patient and resources, goal setting, implementing, maintaining and evaluating process. Goal is to complete within 24 hours.
- Coordinate all discharge activities.
- Initiate all appropriate referrals to continuum of care agencies in a timely manner.
- Facilitates patient transfer from one level of care to the next.
- Incorporate the highest standard of professional, clinical, legal and ethical practice into their own daily practice (i.e. patient’s rights, maintains confidentiality, role model to nursing).
AGE SPECIFIC COMPETENCIES:
Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process. This includes:
- Knowledge of growth and development
- Ability to interpret age specific data and response to care
- Ability to provide age specific communication
- Knowledge of appropriate resources available (homecare, SNF, infusion, rehab)
JOB KNOWLEDGE AND SKILLS:
- Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities
- Working knowledge of InterQual or designated screening tool to Tufts Medical Center
- Competencies of this role include but are not limited to:
- Continuous Learning – Assesses own strengths and weaknesses; seeks feedback to improve performance; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.
- Corporate Responsibility – Adheres to rules, regulations and policies; understands and respects patient rights; performs duties in an ethical manner; operates within scope of position.
- Performance Improvement – Demonstrates an understanding of the performance improvement process; participates in performance improvement efforts, seeks ways to improve systems and services; focuses on achieving patient/client satisfaction.
- Analytical – Synthesizes complex or diverse information; collect and researches data; uses intuition and experience to complement data; designs work flows and procedures.
- Diversity Awareness – Demonstrates an understanding of diversity; demonstrates an understanding of the value of diversity; displays respect for others by utilizing inclusive behaviors; contributes to a harassment-free work place; assists all patient, clients, residents and employees.
- Professional Responsibility – Meets attendance and punctuality guidelines; adheres to appropriate dress code; attends required meetings and in-service programs; maintains current certifications and licensing; completes mandatory annual education.
- Bachelors Degree required, Bachelors Degree in Nursing preferred.
- BLS Certification required
- Minimum of three years Case Management experience required
- Current MA License Registered Nurse
WORKING CONDITIONS/PHYSICAL DEMANDS:
- Prolonged, extensive or considerable standing/walking
- Contact with patients under a wide variety of circumstances
- Subject to varying and unpredictable situations
- Subject to irregular hours
- Work requires some typing/computer keying
- May be exposed to the risk of bloodborne diseases and other transmissible infections
- May have contact with hazardous materials and/or chemicals
All your information will be kept confidential according to EEO guidelines.
AMERICANS WITH DISABILITIES STATEMENT:
Must be able to perform all essential functions of this position with reasonable accommodation if disabled.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.
Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.
See more jobs at Tufts Medical Center
Apply for this job