Supv, Care Management New! Case Management | Full-Time | Gilbert ...Read More Quick Apply! Case Mana

The position provides comprehensive care coordination for patients as assigned and assesses the patient’s plan of care. Develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, advocating and facilitating options and services to meet the patient’s health care needs. Assists the Manager, Case Management with the daily operational activities by monitoring quality and effectiveness of workflow, problem resolution and troubleshooting issues, and processes improvement plan to ensure optimum efficiency for the department and compliance with all regulatory and licensing requirements. This position provides leadership of patient care services and directs supervision of staff, conducts performance evaluations and implements disciplinary actions. Formulates employee orientation structure and provides ongoing education and information to staff regarding best practices, Case Management structures, functions and use of clinical guidelines. This position works independently receiving supervision of work activities from the Manager of Case Management. Position Duties Leadership

1. Provides guidance, mentoring, and direction as appropriate for ongoing staff development and retention.
2. With the Medical Director of Utilization Management and the Care Management leadership team plans, recommends and implements approved protocols, policies, and guidelines and supports overall organizational values and mission.
3. Participates in hospital and departmental operational initiatives to evaluate and improve reimbursement, denials, level of care, goal length of stay and improve delivery care methods.
4. Functions as part of a leadership team with the Lead CM, Manager of CM and Director of CM on operational changes, quality improvement and or productivity issue for the Care Management Department.
5. Coordinates work activities of assigned staff to ensure achievement of established goals, objectives, and outcomes.
6. Leads employees through ongoing goal setting, training and performance feedback.
7. Evaluates performance of case managers and completes performance appraisals.
8. Provides team leadership, demonstrates strong, consistent clear communication and serves as a central point of information informing all team members.
9. Keeps families and patients involved and informed as demonstrated by feedback.
10. Cultivates and maintains effective interaction/communication with members of the interdisciplinary care team and families to drive the care coordination process and to facilitate continuity of patient care.

Coordination of care

1. Manages a defined service line patient population to achieve optimal discharge and continuity of care outcomes in a manner that promotes sound financial stewardship and patient-family advocacy.
2. Completes an initial screen of all patients on admission (not to exceed within 24 hours of admission) utilizing MCG criteria to identify needs related to care coordination and/or discharge planning.
3. Leveraging MCG and other evidence-based guidelines, coordinates, development and implementation of a comprehensive discharge care plan in collaboration with the clinical care team.
4. Ensures plan of care is in place with all team members. Proactively collaborates with members of the interdisciplinary clinical care team to define and document a clear and comprehensive treatment plan, including post-discharge needs. Identifies and facilitates resolution of variances in the plan of care that may impact length of stay. Facilitates referral to other disciplines, and monitor for appropriate follow-up.
5. Facilitates and provides on-going communication with patient/family and escalates unresolved barriers to timely discharge to Case Management, Manager or Utilization Management Medical Director, as per department protocols.
6. Reviews and analyzes third-party payer denials for in house patients and communicates to attending physician, Case Management, Manager, Utilization Management Medical Director and Utilization Management Nurse as per department protocols.
7. Cultivates and maintains effective interaction/communication with members of the interdisciplinary team. and proactively engages patient and families in the care coordination across the continuum of care.
8. Reviews the patient daily for appropriate patient status and goal length of stay per the established Case Management prioritization protocol and per MCG criteria and communicates goal length of stay to clinical care team and patient and family.
9. Keeps patient discharge information current in Case Manager EMR documentation. Assesses each patient’s status and activities daily as appropriate to patient needs. Ensures timeliness of care and identifies barriers to transition of care or discharge.
10. Participates in interdisciplinary rounds or service line rounds with clinical care team.

Develops collaborative health care team

1. Collaborates with clinical care team partners on level of care, goal length of stay, identified barriers, and other issues that may impact reimbursement.
2. Establishes a collaborative relationship with the interdisciplinary team, hospital revenue cycle management and staff, and community providers. Mentors internal members of the health care team on utilization management and managed care concepts.
3. Identifies from review of documentation, opportunities for increased education with physicians and the health care team.
4. This position performs onsite job duties and responsibilities at Phoenix Children's, and is viewed as an accessible member of the health care team.
5. Participates in weekly department process improvement meetings.

Regulatory Responsibilities

1. Reviews the patient daily (Observation and Inpatient) for appropriate status and meeting admission or discharge criteria.
2. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct ongoing care planning and discharge planning.
3. Utilizes MCG criteria/guidelines/paths to determine admission status, level of care, goal length of stay and continued provision of services as evidenced by audit of documentation in EMR.
4. Documents avoidable days, extended length of stay, authorizations and denials for medical necessity in EMR and financial applications as evidenced by audit.
5. Communicates to Utilization Management Nurse data supporting denial appeals, or notification of potential denials.
6. Communicates with payers to resolve potential denials.
7. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct ongoing insurance reviews.
8. Manages a defined service line patient population to achieve optimal outcomes in the most cost-effective manner.
9. Working knowledge of DRG payment methodology and ICD-9/10 coding system.
10. Provides Medicare/Tricare Rights and Detailed Notice of Discharge to patient and families.

Transition/Discharge Planning

1. Assures thorough, early and ongoing transition/discharge plans by collaborating with patients, families, payers and providers across the continuum of care.
2. Assesses patient for appropriate discharge placement. Identifies presumed discharge location on admission.
3. Consults with social services and other resources as needs or problems are identified.
4. Communicates transition/discharge plans and problems to other case managers as care is transitioned. Ensures that health care team is proactive in making arrangements for transition/discharge, and ensures that each transition/discharge plan has clear goals that are attainable. Ensures that all elements of patients' needs are addressed in the transition/discharge plans.
5. Validates that family and patient are aware and understand discharge plan as demonstrated by documentation and feedback.
6. Ensures that education and teaching for family and patient to support transition/discharge is begun as quickly as possible with the health care team.
7. When appropriate, performs outpatient and clinic care coordination and monitors patients care as they transition between inpatient and outpatient service.

Internal Communications/Customer Service

1. Establishes a collaborative relationship with interdisciplinary team, community providers and Hospital Revenue Cycle management and staff.
2. Provides excellent service routinely in interactions with all customers, i.e. coworkers, patients, visitors, physicians, volunteers, etc.
3. Responds to emails within 24 hours.
4. Clear communication skills with all internal and external customers.

Miscellaneous Duties Performs miscellaneous job related duties as requested. Phoenix Children's Mission, Vision, & Values Mission To advance hope, healing and the best healthcare for children and their families Vision Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education. We realize this vision by: Offering the most comprehensive care across ages, communities and specialties Investing in innovative research, including emerging treatments, tools and technologies Advancing education and training to shape the next generation of clinical leaders Advocating for the health and well-being of children and families Values We place children and families at the center of all we do We deliver exceptional care, every day and in every way We collaborate with colleagues, partners and communities to amplify our impact We set the standards of pediatric healthcare today, and innovate for the future We are accountable for making the highest quality care accessible and affordable Position Qualifications Education

1. Bachelor’s degree in Nursing or a combination of Associates degree in Nursing coupled with 3 years clinical experience. Required
2. Master’s degree in Nursing. Preferred

Experience

1. Minimum of one year of supervisory or management experience and minimum of two years of broad clinical experience, predominately in pediatric care. Required
2. Care coordination, case management, discharge planning and utilization review experienced. Preferred
3. Working knowledge of the financial aspects of third party payers and reimbursement. Required
4. Working knowledge of ICD-9 and ICD-10 coding requirements. Required
5. Working knowledge of hospital resources, community resources and resource/utilization management. Required

Special Skills

1. ACM Super-user. Preferred
2. Extensive MCG criteria knowledge. Required
3. Moderate to expert computer skills. Required
4. Effective decision-making/problem solving skills, demonstration of creativity in problem-solving, influential leadership skill. Excellent communication skills, both written and verbal. Required
5. Bilingual (Spanish). Preferred

Additional Requirements

1. Current State of Arizona RN license. Required
2. Current BLS Certification for Healthcare Provider from the American Heart Association. Required
3. Case Management Certification. Preferred
4. Valid AZ Department of Public Safety (DPS) Fingerprint Clearance Card. Required

Physical Requirements & Occupational Exposure/Risk Potential

1. Physical Requirement - Feeling (sensing textures and temperatures) - Frequently
2. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Constantly
3. Physical Requirement - Hearing - Constantly
4. Physical Requirement - Pushing/pulling - Occasionally
5. Physical Requirement - Reaching - Occasionally
6. Physical Requirement - Sitting - Constantly
7. Physical Requirement - Standing - Constantly
8. Physical Requirement - Stooping/crouching/kneeling/crawling - Occasionally
9. Physical Requirement - Talking - Constantly
10. Physical Requirement - Walking - Constantly
11. Physical Requirement - Near Vision - Constantly
12. Physical Requirement - Far Vision - Constantly
13. Physical Requirement - Color Discrimination - Constantly
14. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly
15. Physical Requirement - Lift up to 35 pounds without assistance - Occasionally
16. Physical Requirement - Lift more than 35 pounds without assistance - Occasionally
17. Occupational Exposure/Risk Potential - Inside office environment - Applicable

I have reviewed the qualifications, physical requirementsand occupational exposure/risk potential for this position and wish to apply I Agree #J-18808-Ljbffr Phoenix Children's Hospital, Inc.