Licensed Vocational Nurse/Case Management Coordinator, Case Management

Case Management Coordinator Education:

Associate degree or

Licensed Vocational Nurse Work Experience :

1-2 years of recent acute care experience or 1-2 years of recent skilled nursing home experience or 3-5 years of other related healthcare experience

Required Skills, Knowledge and Abilities :

Ability to demonstrate advanced communication and interpersonal skills with all levels of internal and external customers, including but not limited to medical staff, patients and families, clinical personnel, support and technical staff, external agencies, and members of the community. Ability to engage in complex clinical decision-making. Ability to show strong commitment to interdisciplinary collaboration and communication. Ability to demonstrate strong computer skills, knowledge of Microsoft Office products necessary. Ability to demonstrate strong critical thinking and analysis skills and conflict resolution. Ability to demonstrate excellent human relations skills. Ability to show creative problem solving. Ability to be proficient with organization and planning. Ability to show initiative and work with no supervision. Ability to tolerate frequent interruptions and demanding workload. Ability to become proficient in applicable software programs within 6 months of hire.

Essential Job Functions :

Demonstrates consistent adherence to company policies and procedures related to attendance and tardiness, professional appearance, corporate compliance, and applicable legal requirements. Communicates using the components of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you). Collaborates with internal and external customers functioning as the primary point of contact both in person and over the phone. Answers department office phone and provides routine general information to customers, routing to team members as required. Schedules and coordinates meetings and external mailings as required. Responsible for maintaining a neat and organized department supply room, coordinating the purchase and distribution of supplies, replenishing manufacturer coupons and maintaining the supply/copies of required forms. Keeps up with incoming and outgoing mail and distributes as needed, including uploading into Medical Records, routing to other departments or scanning into the department shared drive. Completes departmental fire drill critiques, environment of care audits, manages the electronic fax folder and distributes case manager patient assignment list to UR and Hospitalists. Establishes an organized department shared drive of pertinent information, contacts, instructions and forms, with continued ongoing maintenance of the drive as new or revised data is received. Prepares the Case Management On-Call Schedule monthly and distributes as required. Tracks patients for receipt of insurance authorization for inpatient or observation length of stay, enters authorization into the Dragonfly system, routes to medical records and notifies Manager of UR of any received denials or adverse determinations in a timely manner. Assists the Case Managers as needed in sending referrals to outside agencies, following up on outstanding equipment delivery and arranging patient transport as needed. Assists the Case Managers with the delivery of the Important Message from Medicare (IMM) to patients transitioning from Observation Status to Inpatient Status by tracking these conversions daily, along with assisting with delivery of the IMM on discharge as needed. Submits for EMS pre-authorization for nonemergent transport for Case Managers by completing insurance specific forms and attaching clinical documentation, follows up to ensure receipt of authorization letter and submits to EMS provider for billing purposes. Conducts monthly chart audits for compliance metrics as assigned by CM Director, updating tracking tables for monthly compliance meetings and quarterly UM Committee meetings.