Responsibilities Assists in meeting the psychosocial needs of patients and families, through assessment ofinpatients based on assignment. Patients are screened for continuing care needs, including emotional support, community resource needs, home care, in patient care and health insurance issues. The Case Manager will assess patients and conduct medical insurance reviews for them. Educates, coordinates, and collaborates with nurses, physicians, Continuing Care Coordinators and interdisciplinary members of the Healthcare team, to assure an ongoing comprehensive discharge plan. Ensures appropriate use of resources within an appropriate length of stay. Collaborates with the multidisciplinary team on the patients treatment plan. Reviews admissions and continued stays in accordance with established criteria. Conducts all adjunct procedures such as referrals to the Medical Director, keeps statistics, performs insurance reviews, and identifies quality of care issue. ESSENTIAL FUNCTIONS/RESPONSIBILITIES Under the immediate supervision of the Director of Case Management, and Vice President for Medical Affairs, a successful employee must demonstrate competency in the following areas: Utilizes electronic Utilization Management platform for assigned units/patients and assesses the patients medical, social, financial, and psychological status within three days of patients admission. A Case Manager is assigned to assess all patients in the Intensive Care Unit and manage their discharge plan until the patient transfers to another level of care. The CM, through assessment and reassessment, will manage the discharge planning needs of the patients assigned to them and review cases for quality of care and utilization management issues. CM will consult CCC team member for the discharge planning needs of patients who are on palliative care, patients that are substance abusers, homeless and uninsured, patients, victims of domestic violence, elder abuse, and child abuse, patients who need referrals for inpatient and outpatient terminal care, inpatient, outpatient psychiatric care, Subabcute and Acute Rehab placements, Home Visiting Nurse services and patients living in assisted living facilities, group homes and adult homes. The dedicated CCC will be consulted for patients newly diagnosed with cancer for community support services. The CCC will be consulted for patients who require guardianship and the CCC will follow through on their discharge plan. A Case Manager is assigned to the Emergency Department and will consult the CCC for any social needs. Counsels the patient and significant others in the admitting criteria and referral process to the below services. CM will follow through on these referrals to ensure a safe discharge plan. Case Manager is responsible for the completion of PRIs and Screens, to issue the Important Message from Medicare during regular department hours as needed and to follow through with IPRO if the patient requests an appeal. CM will refer cases to the CCC and assist as needed such as: Visiting Nurse ServicesInpatient Skilled Nursing Care and Acute RehabilitationLong Term Home CarePersonal Care ServicesHome Infusion Therapy and Wound CareOrdering of Durable Medical Equipmentother community resources as needed Counsels patients and their families in relation to anxieties and stress precipitated by illness and hospitalization, difficulty in coping with residual disability, fears related to helplessness, loss of capabilities, and death. Collaborates with community professionals in order to develop a discharge plan and continuity of care. Works with CCC and obtains community resources in order to develop discharge plan for the patient. Maintains a resource file and follows referral procedure to extended services available for patients, to meet their needs.Utilizes interview skills to determine:Patients discharge planning goalsFamilys discharge planning goalsNeed for institutional and/or specialized careMulti-disciplinary teams goals for patient including (primary care physician, primary care nurse, continuing care coordinator, physical therapist, visiting nurse, speech pathologist, dietician)Incorporates a,b,c,d, into an appropriate discharge plan for the patient Assists in obtaining MD order and insurance authorization for the patients post hospital needs; i.e:Certified Home Health AgencyInpatient Skilled Nursing Care and Acute RehabilitationInfusion therapy, wound careMedical supplies and equipmentTransportation Communicates to the patient their right to seek services outside of the authorization of their insurance carrier as long as they will assume responsibility for payment of these services. Assists family members and significant others in arranging for burial of a patient which may include obtaining community resources, contact with clergy and other family members. CM is assigned to do pre assessment, initial discharge planning and overview of community and residential services for patients admitted through Same Day Surgery preparing for total joint replacement. CM is also assigned to the Ambulatory Services Unit for discharge planning needs. Collaborates closely with hospital benefits area in identifying change of benefit status or lack of insurance. Participates in the performance improvement activities of the department by monitoring length of stay and denials. Refers cases regarding quality of care and utilization issues to appropriate administrator i.e. AVP for Performance Improvement, VP for Medical Affairs, ICP or Assistant Director of Case Management. Performs medical insurance reviews concurrently and retrospectively as assigned. Collaborates with Physician and Nursing to provide medical necessity criteria to the payor. Assists in the appeals process by documenting crucial areas with in the stay that could have been improved or were necessary to justify the stay. Assumes responsibilities of CCC as needed when CCC staff is limited. .Assumes other responsibilities when assigned. Qualifications Must be a NYS licensed RN, Bachelors preferred, with at least 3 years discharge planning or Case Management experience preferred. New York State PRI assessment certification desirable. Able to read, write, speak, and understand the English language. Ability to communicate Spanish or community dominant language is an asset. Effective professional rapport with physicians, patient, family/visitor, peers and supervisors. Sensitivity and Compassion.Knowledge of the services of the community, health, welfare, and social agencies. Demonstrates flexibility and creativity. Must be able to function well under pressure. Must have good leadership ability and good judgment. Must have good mental and physical health. Must be educated in the use of the particulate respirator (mask).