Job Description

This role involves providing comprehensive case management and discharge planning for patients in an acute hospital setting. The Case Manager will conduct patient assessments, develop and implement care plans, coordinate services, and ensure appropriate utilization of resources. Experience in acute hospital care, geriatric care, and working with patients with communication challenges is essential. The position requires strong documentation and communication skills, knowledge of regulatory requirements, and proficiency with electronic health records.

Location: Edmonds, Washington, United States,

Responsibilities:

- Conduct initial patient evaluations and develop comprehensive care plans.
- Coordinate services with home care agencies, rehabilitation facilities, and other healthcare providers.
- Participate in care conferences and interdisciplinary team meetings.
- Perform discharge planning, including arranging for transportation and home health services.
- Utilize InterQual and Milliman guidelines for utilization management.
- Manage appeals and denials related to patient care.
- Conduct concurrent and retrospective reviews of patient stays.
- Assess patient response to treatment and document progress.
- Perform psychosocial and biopsychosocial assessments.
- Maintain accurate and complete patient records according to established standards.
- Provide patient and caregiver education.
- Handle referrals to other disciplines and resources.
- Adhere to all relevant regulatory requirements (CMS, HIPAA, etc.).
- Utilize electronic health record systems (Epic, Cerner).
- Float to different units as needed.

Required Skills & Certifications:

- Master's degree in Social Work (MSW).
- Washington-issued post-MSW license (e.g., Licensed Social Work Associate Independent Clinical).
- Case management and discharge planning experience.
- Experience with acute hospital patients, including those with communication problems.
- Knowledge of Advance Directives, Americans with Disabilities Act, Adult Protective Services (APS), and relevant social work ethical codes.
- Proficiency in documentation according to plan of care and reflecting coverage criteria.
- Experience with major disease processes (Dementia, Stroke).
- Knowledge of regulatory requirements (CMS, CPT coding, Department of Health, DRG, HEDIS, HIPAA, ICD-10 coding, NCQA, OSHA, The Joint Commission).
- Proficiency with electronic health record systems (Epic, Cerner).
- BLS certification.

Preferred Skills & Certifications:

- Utilization management experience.
- Experience with additional major disease processes (Cancer, CHF, COPD, Diabetes, HIV/AIDS, Immune Deficiency, Neurological Disorders, Paralysis, Psychiatric Disorders).
- Experience with Geriatric Depression Scale and Mini-Mental State Examination.

Special Considerations:

- Willingness to float between units.
- Must have at least 3 months separation from any Providence affiliated facility if previously employed there.
- Local candidates will be considered at a travel rate.
- Travel experience preferred.

Scheduling:

- Scheduling details not provided. Information on shift type, assignment process, and on-call expectations is not available.

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