Functioning within the Health System’s mission, values, objectives, policies and procedures, the Care Coordination Manager (CCM), as part of a multidisciplinary team, including physicians, and payers, ensures the patient’s progress in the acute episode of care through post discharge and is quality driven while being efficient, cost effective, and safe discharge plan. The CCM is patient focused and outcome oriented. The CCM works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization. The CCM works collaboratively with all members of the multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted, and that resources are efficiently and effectively utilized. The CCM seeks the expertise of social workers to resolve psychosocial patient care issues and to develop complex patient transition/discharge plan as needed. The incumbent interacts with patients, family members, healthcare professionals, community, and state agencies in this effort. The CCM serves as an advanced clinical resource to the team and functions in a supervisory capacity through the direction, guidance, and training of others. The Care Coordination Manager serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The CCM is responsible for maintaining hospital compliance with the Quality Improvement and CMS guidelines. The CCM is knowledgeable of third party payer requirements, utilizes medical necessity criteria as a tool to assess appropriateness of level and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential risk management issues. The associate performs duties and tasks in accordance with performance standards established for the job. This job requires the ability to interpret age-specific response to treatment, to use age-appropriate communication and knowledge of age-specific community resources.
Education: Graduate of an accredited school of nursing, BSN required.
Licensure/Certification: Valid unrestricted license with the Ohio Board of Nursing. Certification in case management and/or utilization review preferred. BLS required or obtained within 3 months of hire.
Experience: Minimum of three to five (3-5) years clinical experience required. Critical Care experience preferred. Care coordination knowledge and experience, particularly across the continuum, preferred. Payer experience preferred. Acute care setting knowledge and experience preferred.
Skills: Must possess critical thinking and positive communication skills, be motivated and self-directed, and have the ability to integrate numerous job responsibilities. Must also have:
Working knowledge of:
- Levels of care as defined in home care, nursing home, sub-acute and alternate sites established by standards and third party payers
- Severity of illness and intensity of service criteria and discharge screens
- Insurance contracts and how they impact on the continuum of care
- Role of State and Federal governmental agencies as they relate to healthcare
- Age and cultural differences unique to the patients served
- Nursing management of disease processes
- Previous utilization, case management or bed management experience preferred.
Work independently using the professional skills listed below:
- Excellent verbal and written communication skills.
- Excellent critical thinking and problem solving skills.
- Judgment and priority setting
- Ability to act in an autonomous, self directed manner
- Ability to receive multiple stimuli from multiple sources simultaneously
- Time management
- Organization and delegation
- Negotiation and conflict resolution
Must possess the following personal qualities:
- Be self-directed
- Be flexible and committed to the team concept
- Demonstrate teamwork, initiative and willingness to learn
- Be open to new learning experiences
- Accepts and respects diversity without judgment
- Demonstrates customer service values