Kettering Medical Center CASE MANAGER in Hamilton, Ohio

Description aborates with health care team on the plan of care, referrals and ongoing needs of the patient. Facilitates communication and coordination of this plan of care with the attending physicians with the goal to increase quality, efficiency, and patient satisfaction while maintaining LOS. Does admission reviews, identifies delays in services, and works with appropriate individuals to get resolution. Works with an interdisciplinary team to give patient information, education to transition to the next level of care. Collaborates effectively with social services to form a cohesive plan of care to move the patient onto the next level of care. Helps develop, revise, and evaluate tools to facilitate care coordination. Participates in process and quality improvements to improve outcomes. Collects data on resource management, LOS, and other quality initiatives under the department Director, to include core measures and pathway compliance to improve patient outcomes. Conducts reviews on admission, for continued stay and ancillary services to evaluate if they are medically necessary and they are provided in the appropriate setting. Also ensures documentation supports level of care criteria. Assists with placement of the patient in the appropriate status to ensure appropriate use of resources. Escalates outliers for a second level of review. Communicates effectively using both written and verbal communication, with third party payers to assure appropriate reimbursement for services. Participates in unit rounding as applicable to discuss plans of care, discharge needs, expected LOS, and barriers to appropriate care or discharge. Interacts effectively with physicians to ascertain clinical findings to support SI/IS criteria and LOS guidelines. Obtains precertification for assigned diagnostic tests. Integrates new technology to optimize patient care and process outcomes.

Requirements General office environment or computer work on the hospital units often with space limitations. Frequent travel to nursing units or into patient rooms. Handles confidential patient care information. Work is subject to short deadlines, possible frequent adjustments to schedule or work priority. Registered Nurse with a current license to practice in Ohio. 3 years Utilization Management, Discharge Planning, Documentation Specialists, Case Management experience preferred. BSN/BS from an accredited school required, Master’s degree preferred

Requisition Number: 16-7507



Location: Fort Hamilton Hospital

City: Hamilton

Shift: First

Job Status: Full-Time

Temporary: No

Hours per Bi-Weekly Pay Period: 80