A Day in the Life
The Patient Care Manager facilitates progression-of-care; and monitors the patient's progress to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective.
Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
Uses effective customer service/interpersonal skills at all times.
Maintains working knowledge/experience in utilization management, managed care, and payer issues that may impact the course of care.
Timely response to screening referrals for case management services.
Ability to identify appropriate community resources on assigned caseload and to work collaboratively with patients, families, and multidisciplinary team and community agencies to achieve desired patient outcomes.
Confirm admission diagnosis and identify related quality/care metrics to promote medical compliance.
Advocate for patient by assessing that patients healthcare needs are being addressed in the most appropriate level of care.
Encourages and facilitates patient/family participation in all care and treatment decisions.
Educates members of the patient's healthcare team on the appropriate access to, and use of various levels of care.
Identifies patients at risk for readmission and refers them for community based follow up. Recognizes and responds appropriately to readmission or psychosocial risk factors.
Consults with physician advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels.
Serves as primary liaison between and among physicians, patients, families, payers, external case managers and interdisciplinary clinical team.
Participates in discharge planning activities for complex patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers. Refers appropriate cases to the Complex Discharge planner.
Collaborates with Post-Acute Coordinators to monitor and facilitate the progress of completing complex post-acute services.
Interface with utilization review specialists to stay current on patient's eligibility for admission, continuing stay or readiness for discharge according to medical necessity guidelines. (InterQual criteria)
Persevere in attempts to influence clinical and financial outcomes of care. Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes.
Participates in quality improvement plan activities and any other departmental research or studies as requested by the department manager.
Assertively manage resource utilization while appropriately navigating the patient's movement along the continuum of care.
Collaborate with social workers, counselors and Resource Center coordinators to research discharge placement options, when home discharge is not possible, while continuing to focus on patient/family goals, interdisciplinary team recommendations, available payer benefits and private financial considerations which may impact placement.
Utilizes the Program Manager, Director and Medical Advisor as expert advisors to gain insights in dealing with physicians and Resource Management issues.
Works with resource center and providers to determine patient's eligibility for post-acute services.
May assist in training and orientation of new department employees and students. Performs other duties and responsibilities as assigned.