Lead Case Manager
Company: UW Health Rehabilitation Hospital
Location: Madison
Posted on: September 19, 2023
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Job Description:
DescriptionWhat makes UW Health Rehab Hospital a great place to
work?---- Our--PEOPLE, of course!
We answer the call because we have a fundamental need to help
people. In return, we get to work in an environment with leaders
who strive to optimize job effectiveness, assure positive
experiences and job satisfaction.
Your career growth begins when you join an interdisciplinary team,
where doctors, nurses, therapists and other experts work together
to form individualized care plans for our patients. Opportunities
through our continuing education programs, apprenticeship programs,
and tuition reimbursement programs, not only allow for continual
career growth but emphasize our commitment to investing in our
employees and developing future healthcare leaders.
UW Health Rehabilitation Hospital--is a free-standing, 50-bed acute
inpatient rehabilitation facility located on the east side of
Madison, Wisconsin.---Our hospital offers specialized rehab
programs for people who have experienced stroke, brain and
spinal-cord injuries, amputations, complex orthopedic injuries and
many other conditions. We create individualized plans of care that
address both intense rehab and acute medical needs.---Our goal is
to help patients achieve their highest level of function and return
home as soon as possible. The UW Health Rehabilitation Hospital is
a partnership between UW Health, Unity Point-Meriter and Kindred
Healthcare.
Why work at UW Health Rehab Hospital?-- Be part of a team
recognized by--Newsweek--as one of America's Best Rehabilitation
Centers dedicated to patient hope, healing, and recovery.
JOB SUMMARY:
Provides leadership for the case management team and oversees the
hospital Case Management Department's daily activities. Coordinates
the integration of Social Services/Case Management functions into
the patient's care plan, and discharge planning processes and
communicates as needed with hospital departmental staff, external
service organizations and agencies, payers, and health care
providers to ensure the patient's care needs are met. Facilitates
team conference to help ensure care coordination throughout the
patient's hospital stay and communicates with patient and patient's
caregiver(s) as needed to ensure continuity of care, promote
caregiver engagement and set expectations of length of stay and
anticipated plan for discharge.
Provides ongoing support and expertise through comprehensive
assessment, care coordination, plan implementation and overall
evaluation of individual patient needs while ensuring patient
preferences.------------------------------------ Enhances the
quality of patient management and experience, to promote continuity
of care and cost effectiveness through the integration of case
management functions.-- Serves as a patient advocate and performs
ongoing staff education related to resource utilization, care
coordination, discharge planning and psychosocial aspects of
healthcare delivery.----Promotes the hospital's mission, vision,
and values.
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ESSENTIAL FUNCTIONS:
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Responsible for annual performance reviews and ongoing job
performance of all case management staff.
Responsible for facilitating the hospital's quarterly Utilization
Management Committee ensuring compliance with CMS' Conditions of
Participation
Responsible for leading and coordinating departmental specific
performance improvement initiatives and reports all PI activities
to the hospital's Quality Improvement Committee.
As appropriate, consults other departmental staff to collaborate in
patient care delivery, identify barriers to care and or discharge
and develop solutions/resolution.
Ensures case management documentation is completed and thorough per
workflow timeline requirements including completion of the
Individual Plan of Care (IPoC) as per CMS guidelines.
Schedules family conferences and/or communicates with caregiver
following each team conference and more often as needed to keep
patient and designated caregiver informed of progress and provides
appropriate information related to goal achievement, course of
rehabilitation stay, and plans for discharge.--
Coordinates weekly patient care team conferences to facilitate
development, monitoring and refinement of treatment plan to achieve
identified patient goals and outcomes.
Reviews the patient's assigned CMG and helps the team identify any
potential missed comorbid conditions that are actively being
treated during the patient's stay. Communicates any findings to the
HIM team.--
Participates as the facility representative for national internal
CM Conference calls and communicates new information to the
facility CMs.
Assists/trouble shoots difficult discharge planning/placement
cases.
Supervises employees involved in concurrent and retrospective
utilization review activities including assisting with denials and
appeals. Works with physicians to conduct peer review with payer
medical director when indicated.
Communicates effectively with nursing, therapy and other ancillary
departments to ensure proper utilization.
Ensures clinical updates are provided to all insurance payers when
due and all payer communications are documented in Meditech.
Promotes and builds physician relations by developing strategic and
operational programs and goals by maintaining availability and
visibility with physicians and collaborating closely with physician
advisors in case management activities
Coordinates discharge planning needs including but not limited to;
home health services, physician follow up care, durable medical
equipment, medical supplies, healthcare services, outpatient
therapy, dialysis, skilled nursing care, assisted living care,
hospice care, private duty care, etc. Responsible for coordinating
all patient care needs prior to discharge ensuring a safe thorough
discharge plan. Ensures patient choice is offered and documented as
per CMS' Conditions of Participation for Discharge Planning.
Identifies trends that impact the quality, cost effectiveness,
patient experience and delivery of care services and brings to
hospital leadership meetings for discussion and action.
Performs intake assessment on patient within 24 to 72 hours of
admission, preferably within 48 hours.
Demonstrates an ability to be flexible, organized and function
under stressful situations.
Other duties as assigned.
Qualifications
Keywords: UW Health Rehabilitation Hospital, Madison , Lead Case Manager, Executive , Madison, Wisconsin
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