Requisition Number: 8061 Reg/Temp Regular
Employment Type: Full-Time Shift Day
Work Schedule: .. Location Name University of Utah Hospital
City: SALT LAKE CITY State UT
Department: UUH CST 20A OMC CASE MGMT
As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA
This position provides clinical case management services aimed at enhancing patient-centered care and maximizing outcomes across the patient care continuum from pre-admission through post-discharge. Case management services include monitoring patient care to ensure progress toward desired outcome, addressing patient and family needs, resolving obstacles to effective care, obtaining authorization for services from third party payers and, together with the social work team member, planning for patient discharges.
Knowledge / Skills / Abilities
- Monitors and documents quality of care to ensure patient care plan goals are appropriate and that they are understood and implemented. Routinely assesses client and family response to services, while also measuring care plan effectiveness and necessity. Also identifies patient needs, including those of an ethical and cultural nature, and ensures they are addressed.
- Coordinates case management process from patient's entry into the healthcare system to post-discharge, including outpatient settings. Coordinates care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes.
- Identifies patients who are suitable for case management intervention based on criteria such as cost, case complexity, or frequency of admission. Seeks authorization for case management services from patients and/or families.
- Facilitates cost effective outcomes by determining appropriate level of care based on diagnosis, severity, intensity of services required, and other relevant criteria, using national and regional length of stay standards and community norms.
- Assesses and discusses funding and insurance issues with client, family, and healthcare providers to enhance cost effective utilization of services and quality outcomes.
- Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and reimbursement.
- Identifies actual and potential delays in service requests or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays.
- Works with other team members to plan appropriate and timely discharges.
- Establishes measurable case management goals that promote cost effective, high quality outcomes.
- Supervises technical support staff assigned to individual case management teams.
- Ability to perform the essential functions of the job as outlined above.
- Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
- Knowledge of funding resources and clinical standards and outcomes.
- Ability to provide care appropriate to the population served.
- The Case Manager has the authority to negotiate with third-party payers on benefit levels, eligibility, utilization review, and reimbursement, and must do so in accordance with guidelines from third party payers, HCFA, and other funding sources. Responsibilities must be carried out in accordance with the case manager's professional code of ethics, University guidelines, and state and federal regulations.
- Demonstrated independent judgment to assess and meet client needs. A major challenge is interaction with patients, families, various patient care disciplines, ancillary departments, health care and community agencies, third party payors, and Health Science Center professional schools in coordinating care and services for patients.
- The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
- The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
At least one of the following license(s)
- Two years of professional experience in a clinically related area.
- Current Utah Licensed Clinical Social Worker (L.C.S.W.) certificate for clinical practice.
- Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 30 days of hire under the interstate compact.
- Current license to practice as a Certified Social Worker in the State of Utah.
- Clinic Mental Health Counselor
- Basic Life Support Health Care Provider card through American Heart Association is required or must obtain within one month of hire.
- A Certified Case Management designation.
- Previous experience in clinical resource management activities and third party payer interactions.
University of Utah Health - 20 months ago
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