Position Summary

Is accountable for the delivery of transitional care coordination and administrative management of the social services department on a 24 hour basis. Provides oversight to ensure patients receive initial assessment and ongoing evaluations. Facilitates care of patient by insuring that admissions and continued days are medically necessary, cost-effective, and provided in the appropriate level of care to qualify for reimbursement.

Position Accountabilities

Manages employee(s) providing oversight of task completion for transitional care coordination allocating resources to meet patient/family needs to optimize successful transition from hospital setting.

Maintains established departmental policies and procedures, performance improvement projects, safety, environmental and infection control standards.

Assists in the development of department goals and objectives, established and implements policies and procedures for department operation.

Develops and recommends department operating budget and insures department operations within budget.

Provides oversight and management of intervention, both pre-hospital and in-hospital, for patients and families identified from defined screening criteria, as well as through referrals from members of the health care team. Performs oversight and management of activities of assessment, coordination, planning, monitoring, implementation, and evaluation as appropriate.

Maintains oversight and/or completion of clear and timely communication with the health care team, including documentation in the medical record, to facilitate comprehensive, efficient and appropriate discharge.

Conducts oversight and/or completion of continued stay reviews prior to outside review to determine medical necessity and appropriateness in accordance with established criteria, including, statistical response of completeness compliance.

Keeps the Director informed of problematic cases, especially those involving legal or risk management issues. Maintains confidentiality of all patient information. Ensures optimal reimbursement for fee-for-service patients through detailed chart review.

Performs concurrent review of patient charts to ensure proper resource utilization and employee education.

Reviews performance of employee(s) providing constructive and supportive guidance to improve the quality of their individual performance.

Knowledgeable about current rules & regulations pertinent to areas of responsibility.

Facilitate appropriate resource utilization.

Understand benefits systems & cost benefits analysis, managed care contracts.

Maintain knowledge of case management concepts.

Prepares reports & compile statistical data on monthly and/or quarterly basis as directed. (Example) 30 day admissions. Referral logs, Medicare message completion compliance.

Requests diagnoses from physicians when not recorded on discharge or if information is incomplete.

Serves as principal liaison between medical staff, administration, utilization review, nursing, finance, medical records, and other ancillary operational departments with respect to DRG’s and the resolution of technical issues related to participation in the DRG program.

Enhances professional growth and development through participation in educational programs, current literature, inservice meetings, and workshops.

Implements and adheres to policies which ensure patient confidentiality.

Assists Physician Committee and subcommittees in identifying areas of misutilization, coordinating with the Director of Performance Improvement.

Attends meetings as required, and participates on committees as directed.

Performs other duties as assigned.

Minimum Education - Associate Degree

Nursing Education Preference - Bachelor’s Degree

Required Licensure/Certifications - Current licensure as an LPN or RN in the State of Oklahoma, Basic Life Support

Certification

Preferred Licensure/Certifications - Case Management certification

Experience - 1year inpatient/hospital or job specific experience.

Preferred Experience - Case management, discharge planning or utilization management experience. Three to five years of inpatient/hospital experience