Basic Purpose of the Job
Under the general supervision of the case management manager acts as a patient advocate/case manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost-efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.
Minimum Education
Healthcare professional with degree in health science strongly preferred
BSN or MSW preferred
Minimum Work Experience
Three to five years of acute care hospital experience preferred.
Critical care or emergency department experience highly desirable.
Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking.
Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis.
Knowledge of utilization management as it relates to third-party payers.
Knowledge of post-acute care community resources.
Experience with managed care preferred.
Excellent verbal and written communication skills required.
Demonstrates flexibility via an ability to adapt to changing priorities and regulations.
Basic computer skills required
Salary
USD 52,705 - 76,335 /yearly
Yearly based
Location
GU , United States Dededo, GU, United States
GU , United States Dededo, GU, United States
