General Summary of PositionReview and facilitation of the Continuum of Care to achieve desired clinical outcomes. Outcomes attained collaboratively with participation of patients, family members, physicians, health care providers and others.
Primary Duties and ResponsibilitiesPerforms integrated patient care quality monitoring: Utilizes Medical Staff approved comprehensive monitors that measure/evaluate: o Operative and Invasive procedures o Peri-natal o Infection Control o Stability at Discharge o Utilization o Case Review Immediately notifies the Quality and Accreditation Improvement Department of urgent/critical quality issues. Identifies cases for potential peer review and reports these cases to the Quality and Accreditation Department. Documents all screening and outcome variations according to Quality & Accreditation Department process. Assists MSMHC achieve compliance in the important functions described in the Joint Commission manual.Performs utilization review, regardless of payor source, in accordance with the Utilization Management Plan in accordance with State of Maryland Regulations. Utilizes Medical Staff approved monitors for ongoing measurement/evaluation of utilization management. Maintain current clinical records according to department policy and professional standards and prepares monthly statistical reports. Is available on a rotating basis on weekends, evenings, and holidays with other staff to provide onsite services from utilization review. Performs the . Readily distinguishes between acute, intermediate and skilled levels of care. Contacts managed care companies on a daily basis to assure reimbursement for continued stay. Refers concurrent utilization problems/issues to the Physician Advisor for review.Completes, in a timely manner, admission and continues stay criteria review to obtain Documents assessment, discharge plan, problems, services, and outcomes in the medical record in a clear and concise manner with consideration of the patient's age, developmental needs, diagnosis and employee area of specialization. Makes referrals and arranges for needed services for home care Coordinates multi disciplinary clinical management conferences. Assists the patient and significant other in assessing discharge options and determining a plan for continuing care within the limits of resources, personal preferences, regulations, and medical needs. Assures the provision of clinical social services to meet the needs of our patients and their significant others:Makes appropriate referrals to Pastoral Care to meet the spiritual needs of our patients and significant other. Makes appropriate referrals to community action groups, support groups, etcetera. Complies with the State law for reporting abuse/neglect for children and adults.Completes a psychosocial history and assessment for patients identified as high risk that is maintained as a permanent part of the medical record. Evaluates social and significant other information and assists in determining treatment plans relevant to patient's background, age, and emotional/cognitive needs. Identifies high risk patients (through predetermined screening criteria) and makes prompt appropriate referrals to social services/social workers. Works in concert with Social Workers/Social Services to meet the needs of our patients and significant other. Communicates with others in an effective, professional manner: Maintains confidentiality in accordance with hospital policy. Maintains open communication with MSMHC staff, Communicates effectively, courteously and compassionately with all patients, families, visitors, physicians. Utilizes appropriate channels of communication to address interdepartmental concerns and opportunities for improvement. Serves as patient advocate in assuring a collaborative approach to patient care management.Medical Staff, patients, significant others, nursing and health care providers as appropriate, (internal and external) to facilitate the case management process and enable patients to make informed decisions regarding their plan of treatment and discharge disposition Participates in organizational improvement: Participates in improving processes related to the Continuum of Care, Performance Improvement, and The Joint Commission Important Functions as appropriate. Participates in the formulation and revision of policies and procedures related to the case management process.Demonstrates a commitment to professionalism and self-improvement: Attends required departmental staff meetings. Participates in the Joint Commission related educational programs. Participates in related educational programs that promote clinical and case management expertise. Participates or provides at least one educational program annually for SMHC staff. Accepts other related duties as assigned by the Director.
Minimum QualificationsEducationAssociate's degree in Nursing required Bachelor's degree in Nursing preferred
Experience1-2 years experience required 3-4 years experience preferred
Licenses and CertificationsLPN - Licensed Practical Nurse - State Licensure in Maryland required CCM - Certified Case Manager preferred Certified Professional in Utilization Management preferred
Knowledge, Skills, and AbilitiesAbility to comprehend and follow the policies and procedures for MedStar Southern Maryland Hospital Center.Ability to read, write and speak or communicate in English to successfully accomplish the essential duties of the position.Ability to demonstrate ethical behavior that supports the hospital's mission, values and commitment to compliance with all federal, state and regulatory laws. Inspires trust and exhibits honesty and integrity within the scope of daily activities.Exhibits professionalism, courtesy and excellent customer service, while interacting with patients, guests and co-workers.Ability to work effectively with people from a variety of culturally diverse backgrounds.Ability to maintain patient confidentiality.Knowledgeable of MedStar Southern Maryland Hospital Center's performance improvement priorities and outcomes.Knowledge of Joint Commission, State and Federal regulations as it pertains to Case Management.Ability to set priorities to maximize the overall effectiveness of the function and complete assignments within scheduled hours.Demonstrate initiative in acquiring knowledge to further understand the overall department and hospital functions.Ability to contribute through constructive suggestions and illustrate resourcefulness.Ability to demonstrate responsibility for work performance, consistent good attendance, and resourcefulness to solve case management problems.Knowledge and ability to use a desktop/laptop computer.
Why MedStar Health At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar HealthMedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It’s how we treat people.MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.