The Hospital Safe Discharge Case Manager initiates proactive outreaches to facility CM/UM/Discharge staff upon generating the daily census to manage discharges, working collaboratively with the facility discharging staff to assist in resolving any discharge barriers and continuing to engage facility staff until the actual discharge.
*The schedule for this position is based on Eastern Standard Time Zones; required shifts are 8AM-5PM EST; subject to change depending on business needs.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Assessing barriers to a safe and efficient discharge process, identifying the relevant resources, and finally coordinating and driving an efficient discharge process with both internal and external stakeholders
- Demonstrates exemplary knowledge of acute inpatient case management, utilization management and care coordination processes as a foundation for transition planning activities
- Manages assigned case load in an efficient and effective manner utilizing time management skills
- Prepare and lead periodic rounds to discuss case needs, prioritize patients/discharges/issues/facilities and facilitate the member's transitions of care
- Proficient in utilizing multiple electronic platforms, applications, and Electronic Medical Record (EMR) systems to coordinate patient care, document clinical information, and ensure accurate and timely communication among interdisciplinary teams
- Confers with Medical Director or other leadership as appropriate for review of complex case situations
- Working knowledge of skilled criteria for other levels of care; Skilled Nursing Facility, Acute Rehabilitation, and Home Health
- Identifies and communicates a member's level of risk and participates in planning to mitigate those risks
- Working closely with hospital staff, patients, families, and community services to promote a safe discharge plan and quality care
- Communicates and supports hospital staff in facilitating member transition to other levels of post-acute care
- Cultivate and build relationships, especially where one does not exist or is challenging, with hospitals and their personnel to build a collaborative discharge management relationship
- Continuously look for opportunities to improve and streamline the discharge process, communicating with leadership innovative ideas and opportunities to optimize processes and outcomes
- Collaborate closely with internal and external partners to aggressively drive safe discharges to achieve higher daily discharge volume and overall lower LOS
- Use existing tools and communication platforms to support member transitions of care post discharge
- Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better monthly
- Adheres to organizational and departmental policies and procedures
- Takes on-call assignment as directed
- Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines
- Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
- Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds
- Monitors for any quality concerns regarding member care and reports as per policy and procedure
- Performs all other related duties as assigned
Required Qualifications
- Bachelor of Science in Nursing
- Current, unrestricted RN license - Compact State License
- 5+ years of nursing experience in an acute care setting
- 2+ years of discharge planning experience
- Knowledge of utilization management and quality improvement
- Computer proficiency in Microsoft Office applications including Outlook, Word, and Excel
- Demonstrated ability to read, analyze and interpret information in medical records, and health plan documents
- Proven ability to utilize critical thinking skills, nursing judgement, and decision-making skills
- Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
Preferred Qualifications
- Case Management certification
- 1+ years of recent inpatient clinical documentation integrity (CDI) experience
- Experience working with psychiatric and geriatric patient populations
- Experience with managed care and/or case management experience
- Experience managing patients with SUD and/or Behavioral Health conditions
- Knowledge of CMS coding guidelines and DRG assignment
- InterQual/MCG Guidelines or other nationally recognized practice guidelines
Physical & Mental Requirements
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.