Case Management professional offering strong communication skills and a commitment to patient advocacy and excellence that will enable a meaningful contribution in discharge planning, quality and utilization practices.
▪ Assess, plan, implement, monitor & evaluate options & services to affect an appropriate, individualized plan for hospital patient care across the continuum of care for up to 22 patients.
▪ Participate and collaborate in daily interdisciplinary team rounds including physicians, medical social workers, pharmacy, and physical therapists to discuss barriers to discharge and potentially avoid delays for discharge.
▪ Conduct clinical utilization reviews through Milliman/MCG software in order to evaluate appropriate inpatient and observation status relative to hospitalization
▪ Follow up with insurance companies to provide continued stay patient information.
▪ Deliver Medicare beneficiary's Important Message letter within two days of discharge.
▪ Knowledge of Medicare and Medi-Cal guidelines and commercial coverage plans plus usually covered benefits.
▪ Using independent judgment and discretion assess and reassess the patient as an ongoing process to address the patient's needs.
▪ Utilize clinical knowledge, competence, communication skills, problem solving, and conflict resolution techniques in order to safely and effectively transition patient to next level of care
▪ Ability to affect change with strong skills in assessment, organization, and time management
▪ Focus on critical thinking skills, customer service skills, setting goals and measuring goals to effectively ensure optimal patient outcomes with consideration to financial and health plan resources.
▪ Demonstrate adherence to department & system policies, procedures, quality assurance, guidelines and goals of the department and the overall organization.
Basic Life Support (BLS)
Currently studying for ACM Certification
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