Coordinate with transdisciplinary team to deliver quality, cost-efficient care to patients through the continuum of health care services. Work with the Case Manager to conduct concurrent and retrospective reviews utilizing application established guidelines. Collaborate with Case Managers, patients, families and other members of the health care team to facilitate transition of care through the continuum to post acute services.
Interview and document findings to assist with developing discharge plan. Apply on line InterQual (CERMe) as required. Refer all questionable utilization cases to the RN Case Manager for direction and discussion. Prioritize caseload according to changes in the patient's discharge needs and as directed by the RN Case Manager.
Comply with national and state compliance standards. Such as providing a list for patient selection and documenting outcome of selection.
Attend and actively participate in departmental multidisciplinary, discharge planning meetings. Monitor utilization of resources and services in a quality-conscious manner and in relation to covered services and length-of-stay parameters. Negotiate the utilization and coverage of services with other stakeholders.
Assist patients in benefits management to include proactive negotiation with third-party payers and agencies to optimize payment of services rendered for alternative cost-effective levels of care to activate client needs and interests. Assume a global perspective with regard to the fiscal well-being of the patient, the organization, network and the health care system.
Promote safe, competent discharge planning communicating directly with patient and family to remove any unexpected barriers to a smooth, safe and positive discharge transition. Assuring all questions are answered by the patient and family. Consult with Social Worker, BS to facilitate difficult discharges, nursing home discharges, and other social issues.
Maintain clinical information gathered from concurrent or retrospective review of the medical record and compares to approved standards, pathways or protocols. And input into on line InterQual (CERMe). Write orders to assist the Care Management team to obtain post discharge services.
Participate actively in the collection and analysis of outcome data, e.g., quality, length-of-stay, cost and charge, and identify and make recommendations for improvement within a designated patient population or service line. Monitor length of stay and assist to maintain designed geometric mean length of stay (GLOS).
Serve as a resource and hospital liaison to patients/families, physicians, the health care team and external organizations with regard to the case management program, available health care resources, appropriate level of care and financial issues. Contribute to the development, monitoring and evaluation of the department performance improvement plans.
Demonstrate respect for self and always respects the rights and dignity of others. Recognize patient rights by providing for confidentiality of patient information and by reporting ethical issues through appropriate processes. Accountable for own learning needs and seeks opportunities to increase competencies and to receive feedback.
Function as a liaison for patients and families for their payer pan, knowledgeable about Medicare and Medicaid regulations. Educate nursing staff and physicians about case management programs.
Perform other duties that correspond to the overall functions of this position
Qualifications Minimum Qualifications:
Licensed by the Oklahoma Board of Nursing as a Licensed Practical Nurse.
Two years of recent clinical experience in health care as a licensed practical nurse.
Current CPR (Healthcare Provider).
About SSM St. Anthony's Hospital
St. Anthony Hospital is a 601-bed regional referral facility specializing in cardiology, oncology, surgery and behavioral medicine. The hospital, established in 1898, is located in Midtown Oklahoma City and serves the needs of Central Oklahoma, as well as many counties throughout Oklahoma, through its large rural affiliate network of hospitals. Four St. Anthony Healthplex campuses provide convenient emergency and outpatient service access to the outlying communities of the metropolitan area. St. Anthony added urgent care services in May 2015 at St. Anthony North. St. Anthony has received numerous awards including the Oklahoma Quality Award for Excellence, Certified Healthy Business, Premier QUEST® Award for High-value Healthcare Citation of Merit, among others. Healthsights ranks St. Anthony at performance levels for quality and patient satisfaction higher than local competitors and many national health care organizations.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same