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Description

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DMC Sinai-Grace Hospital is DMC’s largest hospital, offering a comprehensive heart center, cancer care, gerontology, emergency medicine, obstetrics/gynecology and cosmetic services. Sinai-Grace’s joint replacement program features a revolutionary minimally invasive knee and hip replacement surgery that attracts patients from all over the country. Sinai-Grace operates more than 21 outpatient care sites and ambulatory surgery centers throughout Wayne and Oakland Counties and is one of 10 hospitals in the nation to be awarded a Robert Wood Johnson Foundation grant to help set the standards of cardiac care for hospitals and physicians throughout the nation.
Summary Description
The individual in this position is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. The individual in this position has overall responsibility to ensure staff assess patients for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

• Provides assistance to the Director of Case Management in the management of the department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments
• Utilization Management supporting appropriate use of resources
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at the appropriate level of care
• Compliance with state and federal regulatory requirements including state psychiatric holds (Baker Act, 5150, etc.), TJC accreditation standards and Tenet policy
• Provides education to physicians, patients, families and caregivers

POSITION SPECIFIC RESPONSIBILITIES:
Department Operations

• Oversees an adequate number and skill mix of staff over seven days a week to serve the patient population and meet the goals of the department
• Supports and manages staffing requests utilizing the Tenet Case Management staffing recommendations within budgetary guidelines
• Plans and conducts regular departmental meetings with the Director to provide staff updates and ongoing education

• Ensures new Case Management staff complete department orientation including review of Tenet Case Management and Compliance policies and Documentation training

• Assists the Director of Case Management in the management of the department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments

• Monitors case management processes and staff productivity to ensure medical necessity reviews are completed timely and accurately, payer communications are sent and authorizations or denials documented and followed up, and that transition planning assessments are completed timely.

(30% daily, essential)
Utilization Management

• Monitors the review process to ensure staff follow Tenet policy and process for appropriate patient status and level of care
• Oversees submission of cases to Physician Advisor to ensure timely referral, follow up and documentation
• Monitors the timely communication clinical data to payers to support admission, level of care, length of stay and authorization for post-acute services

• Advocates for the patient and hospital with payers to secure appropriate payment for services rendered
• Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes
• Assists the Director in monitoring to ensure that CMS Follow-up Important Message (IM) and HINN letters are delivered and documented per federal regulations and Tenet policy.
• Identifies and documents Avoidable Days using the data to address opportunities for improvement
• Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements.

(20% daily, essential)
Transition Management

• Implements and monitors process to ensure that a transition plan assessment is completed within 24 hours of patient admission to identify and document the anticipated transition plan for patients
• Ensures case management staff use electronic referral request process for patient placements
• Monitors to ensure that patient preference & choice is documented per CMS regulations and Tenet policy
• Monitors to ensure case management staff document in the Tenet Case Management documentation system to communicating information through clear, complete and concise documentation
• Ensures staff are completing comprehensive assessments within 24 hours of patient admission to identify and document the anticipated transition plan for patients
• Integrates key elements of patient assessment, patient choice and available resources to develop and implement a successful transition plan
• Identifies patients at risk for readmission and applies appropriate intervention including risk assessment and referral to Social Work and/or Complex Case Review
• Ensures all elements of the transition plan are implemented and communicated to the healthcare team, patient/family and post-acute providers
• Ensures all Final Discharge Disposition Form are completed for Medicare beneficiaries per Tenet policy
• Addresses and escalates variances in delays in patient care

(20% daily, essential)
Care Coordination

• Participates and leads staff in effective daily TEMPO ®huddles

• Ensures discharge plan is developed and referrals are placed by day 3 of stay
• Monitors readiness for transition, overseeing coordination of care ensuring staff are proactive and prepared for huddles
• Escalates issues to resolve barriers to that are not resolved timely on the nursing unit
• Assists the Director in working with Nursing and hospital leadership to ensure Patient Care Conferences and Complex Case Review processes are in place to promote timely and appropriate throughput

• May participates in daily bed management meeting to support timely and effective patient placement and transfer within the hospital
• Monitors to ensures that patients have a plan of care that is clinically appropriate, consistent with patient preference & choice and available resources
• Monitors to ensures consults, testing and procedures are sequenced to support clinical needs with timely and efficient care delivery
• Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care
• Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes
• Ensures the plan of care is clinically appropriate, consistent with patient preference & choice and available resources

(10% daily, essential)
Education

• Provides education to staff and monitors staff performance on position expectations
• Ensures and provides education to staff, patients, physicians and the healthcare team relevant to the
  • Effective progression of care,
  • Appropriate level of care, and
  • Safe and timely patient transition
• Provides patient and healthcare team education regarding resources and benefits available to the patient along with the economic impact of care options
• Ensures that education has been provided to the patient/family/caregiver by the healthcare team prior to discharge
• Provides in-service education to Case Management Department on policy and key processes to achieve hospital and Tenet outcomes

(10% daily, essential)
Compliance

• Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services
• Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies
• Remains current with Tenet Case Management practices

 
Under general supervision and following established policies and procedures, performs diagnostic radiological exams utilizing appropriate imaging equipment. Verifies patient identity and reviews patient's medical record for appropriateness of exam or procedure. Interviews patient to obtain, verify or update medical history and assesses risk factors such as medications, pregnancy and/or psychological indicators. Explains procedure to patient, including side effects of pharmaceuticals administered, risks, benefits, alternatives and follow-up. Sets up equipment and acquires appropriate images as per script. Reviews images, makes initial observations, documents exceptions from established protocols and communicates data to radiologist. Recognizes and responds to medical emergencies as appropriate. Provides physician-prescribed post care instructions to patients. Participates in process improvement activities within radiology practice including but not limited to quality of care, patient flow, reject-repeat analysis and patient satisfaction. Provides imaging education to residents, student technologists and new employees. Able to take call/standby as required by the department

Qualifications

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Minimum Qualifications
1. Master's degree in Social Work from a college or university social work program approved by the Michigan Board of Social Work and accredited by the Council on Social Work Education.
2. Current license as a Licensed Master's Social Worker in the State of Michigan.
3. Three years of Social Work experience, preferably in a hospital setting. Previous experience with the targeted patient population is preferred.
4. One to two years supervisory/management experience is strongly preferred.
5. Accredited Case Manager (ACM) preferred.
6. Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire. Attendance at hospital and department orientation is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance policies, Transition Management, Utilization Management, and other topics specific to case management and social work services.

Skills Required

1. Analytical ability to create solutions to difficult administrative, technical or human situations, to anticipate and resolve a broad range of issues and concerns on multiple, sometimes unrelated, topics, to determine the need for process development and refinement, to independently evaluate situations and outline ramifications of multiple solutions or options, to recommend goals for a function/area and understand when intervention in current work processes must occur to ensure successful delivery of service.
2. Communication and/or interpersonal skills as well as written communication skills for contact with internal and external customers/stakeholders to obtain and interpret a variety of information based on knowledge of departmental practices, DMC policies and programs and specific technical and regulatory knowledge. Discretion must be exercised in deciding what and how to communicate; conflict resolution skills must be exercised where policy issues are concerned both within the functional area and interdepartmentally. Diplomacy, tact and listening skills are required. Ability to read, interpret and write technical materials.
3. Project management skills including the ability to define program, project, or process objectives, identify stakeholders and their interests, plan steps, coordinate and allocate human, technological and fiscal resources to accomplish goals and objectives in a resourceful yet timely manner.
4. Leadership skills including performance management skills, organizational skills, a demonstrated willingness to pursue leadership roles with increasing levels of accountability, comfort with decision-making responsibilities, coaching, teaching and counseling skills, and the ability to inspire and build confidence in others and to forge alliances and garner support. Ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills.
5. Teaching abilities to conduct educational programs for staff, patients, families and the community.
6. Ability to cope with stressful situations and manage multiple, sometimes conflicting, priorities.
7. Computer literacy.

Job : Nursing

Primary Location : MI-Detroit

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Hospital/Facility : DMC Sinai-Grace Hospital

Job Type: : Full-time

Shift Type: : Days

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