Responsibilities

Responsibilities

Performance Standard

1. Assessment

Does the initial screening of all elective inpatient admissions related to:

· Appropriateness of admission

· Coordinates and supervises data and reporting needs. Provide timely discharge planning.

· Coordinates out-of-area transfers as well as third party contractual arrangements and supervise ground transportation, home health and durable medical equipment.

· Appropriate resource utilization

· Coordinates the pre-admission screening and education of the identified patient populations

· Documents patients admitted directly through Pre-Admissions in the lap to system and forward the information on to the Case Managers as appropriate with discharge planning concerns and the initial discharge-planning screen.

· Utilization and documents patient admitted directly.

2. Technical and Job Specific Skills

• Ensures facility compliance with federal and state regulations involving the Case Management practice.
• Answers inquiries and educate patient, family, MD and hospital employee on discharge follow up.

3. Assists Case Managers with patient transfers and discharges.

• Frequently contact with case manager, charge nurse, bedside nurse, outside facilities to obtain and verify and/or provide information regarding the discharge follow up.
• Utilizes Interqual – Screening criteria for all admissions and observations status patients.
• Collaborate with all respective departments to ensure patient flow during the admission and transfer process.
• Interacts with the Admitting MD as appropriate involving the Physician Advisor as needed for inappropriate admits transfers and level of care.
• Assist case manager on initial screening of all elective inpatient admission related to: level of care, appropriateness of admissions, discharge needs, third party contract arrangements, appropriate resource.
• Utilization and documents patient directly.
• Appropriately prioritize work activities.

Performance/

Process Improvement

· Is aware of and follows all hospital and department policies and procedures.

· Is knowledgeable of performance/process improvement.

· Offers performance/process improvement

Guest/

Interdepartmental Relations

· As observed by representatives of management all interactions are conducted in a professional manner.

· Consistently exhibits phone protocol

· Consistently contributes to the team effort (e.g., assists co-workers when need is observed or upon request, offers constructive suggestions.

Productivity

• Maintains high productivity and performs efficiently
• Appropriately prioritizes work activities
• Responds to difficult situations with self-control and a positive attitude.

Key Success Factors

• Readily accepts work assignments in a positive manner.
• Performs work that is accurate, neat and consistent.
• Documentation is legible
• Reports safety issues and equipment failures appropriately.
• Projects a professional image, follows the hospital dress code policy and/or department requirements.
• Wears hospital ID badge at all times on duty
• Sensitive information including, but not limited to, patient records, charts, hospital documents and employee information is kept confidential without exception.
• Reports to work each regularly scheduled workday

Qualifications

Qualifications:

Minimum Education: Preferred Bachelors of Science/Nursing or Bachelors of Health Care Administration.

2. Minimum Experience: 2 -3 years’ experience in an acute care setting preferred. Working knowledge of InterQual IS-SI Milliman and Robertson Managed Care guidelines, Erickson Life Skills (Age Competencies), Medicare Part A and Part B, Medic-Cal NCQA, HEDIS and other criteria as identified by the Quality/Care Management Department. Working knowledge of Care-M.A.P. development and implementation. Working knowledge of managed care and capitation.

Preferred Certifications: Current and valid CA LVN.