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Case Manager

Company: Sonoma Specialty Hospital
Location: sebastopol
Posted on: May 3, 2021

Job Description:

Our mission is to provide all of our patients with the highest quality long term acute care and transitional care given in the state of California. We are committed to upholding a culture of shared values that provide dignity, growth, and value to our patients, employees and physicians.We believe our hospital will provide a variety of quality services that will not only be an asset to the community but a distinct benefit to the surrounding acute hospitals.It is our vision to become world recognized for our outstanding specialty and long term acute services accomplished through quality, innovation and leadership.The Long Term Acute Care (LTCH) Division of Sonoma SpecialtyHospital is designed to provide care of medically complex patientswho have experienced catastrophic illness and/or multi-system failure and arein need of intense rehabilitation services and an extended stay in an acutecare setting. These patients usually come directly from a Short Term Acute CareHospital (STCH) and are in need of vent weaning and acute rehabilitationservices for a longer period of time to recover and return to their optimallevel of health. The average length of stay (ALOS) of these patients is a rangeof 25-35 days which is a longer than average stay at a Short Term Acute CareHospital. Care for these types of patients is provided by RNs, RespiratoryTherapists, Wound Care Nurses, Physical Therapists, Occupational Therapists,and Speech Therapists. Also a collaborative team of specialty physicians,psychologists, dieticians, and social workers will focus on an individualizedgoal for each patient to recover and reach their independence and optimum levelof a missing piece in the continuum of care within the health caresystem.Job SummaryThe Case Manager is responsible for all case management activities assigned. This includes case management and utilization management. The Case Manager provides concise management of patients' hospitalization from pre-admission through discharge in the areas of patient care, fiscal management, and Payor/referral satisfaction. The Case Manager is responsible for conducting Discharge Planning Evaluations, performing discharge planning to ensure patients and their families receive maximum benefits, and awareness of community and government agencies. This position requires the use of communication skills, the ability to perform management operations directly related to administrative goals and policies, to provide regular and direct assistance to executives, to perform work and special assignments under only very general supervision, and to continuously develop department operations toward efficiency and effectiveness.QualificationsThis position requires a Licensed Nurse with at least three (3) years of work experience in a medical case management setting. Good organizational and liaison capabilities with well-developed written and verbal communication abilities are required. Well demonstrated public relations skills with a cooperative and assertive attitude. Working knowledge of the insurance industry is required.Have an understanding of the commercial insurance appeal processHave a working knowledge of billing ad reimbursement and letter of agreementBe knowledgeable regarding pre-certification and concurrent review processMust have clear and concise professional language in the preparation of up to date clinical reports representing the patient's total condition and treatment planHave working knowledge of Federal and State Regulatory ComplianceHave a good working knowledge and ability to facilitate interdisciplinary team conference identifying clinical challenges and outstanding issuesAbility to discharge patients successfully without adverse health consequences with all needs identifiedDuties and ResponsibilitiesAdmits new clients by reviewing records and applications; conducting orientationsDetermines clients' requirements by completing intake interviews; determining need for therapeutic medical, psycho-social, and psychiatric evaluations; reviewing therapist evaluations, treatment objectives, and plansEstablishes treatment programs by setting schedules and routines; coordinating services being provided; arranging resources, including transportation and escortMonitors cases by verifying clients' attendance; observing and evaluating treatments and responses; advocating for needed services and entitlements; obtaining additional resources; intervening in crises; providing personal supportMaintains clients' records by reviewing case notes; logging events and progressCommunicates clients' progress by conducting weekly interdisciplinary meetings and evaluations; disseminating results and obstacles to therapeutic team and family; identifying treatment influencesPrepares clients' discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members; providing resourcesMeets budget by monitoring expenses; implementing cost-saving actionsPrepares reports by collecting, analyzing, and summarizing treatment and results data and trends; compiling statistics; completing grant and subsidy applications

Keywords: Sonoma Specialty Hospital, Santa Rosa , Case Manager, Other , sebastopol, California

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